Abdominal X-ray - Scenario 2
Answers to scenario questions

Answers to scenario questions

Question 1

What is the radiological diagnosis?

  • Small bowel obstruction.

Question 2

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 3

What clinical history and examination findings are possible at the time the image was acquired?

  • Presenting history: Colicky abdominal pain and distension, nausea, vomiting, diarrhoea (at onset of symptoms), constipation (?absolute).
  • History of cause: Previous abdominal surgery or radiotherapy (adhesions), hernias, known malignancy or inflammatory bowel disease, foreign body ingestion.
  • Examination findings: Reduced conscious level, signs of dehydration with haemodynaimc instability, pyrexia, abdominal distension and tenderness, tympanic abdominal percussion, absent bowel sounds (may be hyperactive if obstruction is incomplete), empty rectum.
  • Examination findings relating to cause: Abdominal surgical scars, hernias (check umbilicus, inguinal/femoral hernial orifices), mass on palpation or digital rectal examination.

Question 4

Which imaging investigation would be most appropriate to perform next and why?

  • A CT of the abdomen/pelvis is usually requested prior to definitive intervention. This is performed to look for the cause and level of obstruction, and to look for evidence of complications such as perforation and bowel wall ischaemia.

Question 5

What precautions are necessary prior to requesting the investigation in question 4?

  • The patient must be appropriately resuscitated and stable prior to transfer to the CT scanner. They must be accompanied by an appropriate level of nursing and medical staff.
  • Assessment of renal function is required as intravenous contrast material (nephrotoxic) will be given for the CT examination. History of previous allergy to intravenous contrast material is also relevant.

Page author: Salisbury NHS Foundation Trust UK (Read bio)

Last reviewed: February 2016