Abdominal X-ray - Scenario 3
Clinical information

Allow yourself ONE MINUTE to consider the following clinical information, then click the Next button to show the scenario image.

Clinical information

Mr Black is a 69 year old man with a complex previous surgical history including previous resection of the sigmoid colon to treat diverticular disease which had been complicated by formation of a colovesical fistula. He subsequently had a reversal of ileostomy, and several year later he presented with bowel obstruction which was treated by adhesiolysis and colostomy formation.

He presented with a short history of increasing crampy abdominal pain and distension, and reported that nothing was emptying into his colostomy bag.

On examination you find he is dehydrated and tachycardic. His colostomy bag - in the left lower quadrant - is empty.

You will be shown an abdominal X-ray, and asked to comment on any relevant findings.

You will then be asked questions about imaging in this clinical scenario.