Abdominal X-ray - Scenario 1
Answers to scenario questions

Answers to scenario questions

Question 1

Regarding image 1- what clinical history and examination findings would you expect to find at the time it was taken?

• Clinical features of bowel obstruction. Vomiting, abdominal pain, absolute constipation, abdominal distension and tenderness, tinkling bowel sounds and an empty rectum on digital examination.

Question 2

What are the most likely causes of the clinical and radiological diagnosis?

• Large bowel obstruction is usually caused by colonic carcinoma or a diverticular stricture. Hernias and volvulus are a less likely cause, unless there are specific clinical or radiological features. Adhesions do not commonly cause large bowel obstruction.

Question 3

Why should a chest X-ray be requested in this clinical setting? (Chest X-ray not shown in this OSCE)?

• In the setting of an acute abdomen an ERECT chest X-ray should be requested to determine the presence of perforation.

Question 4

Regarding image 2 (If not already stated) - What procedure has been performed and why?

• A radiologically placed colonic stent has been inserted to bridge the colonic obstruction. This allows the patient to recover from the acute effects of obstruction before definitive surgery is performed.

Question 5

At CT the patient was found to have an obstructing colonic cancer. What staging system(s) do you know for this disease?

• The TNM (Tumour/Nodes/Metastasis) staging or Dukes' staging.