Abdominal X-ray - Scenario 3
Scenario image interpretation

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Scenario Image Interpretation

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  • Good penetration and coverage


  • Features of large bowel obstruction with very distended (up to 15 cm) gas-filled large bowel with loss of haustral folds.
  • Note the anastomosis wire in the pelvis. This is the site of the previous ileostomy reversal.
  • Some are confused by the presence of lines passing across the full width of the bowel. These are haustral folds (arrowheads). Although they do cross the full width of the bowel, the bowel is not looped in the centre of the abdomen, as in small bowel obstruction, and is too dilated to be small bowel. More importantly the bowel follows the anatomical course of the colon, so the diagnosis of large bowel obstruction can be made.

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OSCE Image Interpretation - Image 2

Answers to OSCE Questions

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Question 1

  • What is this imaging examination and why was it requested?
  • CT abdomen with intravenous contrast. Performed to find the cause and level of obstruction.

Question 2

  • What is the dotted line separating areas 1 and 2? (roll-over image)
  • This line represents a gas/fluid level.

Question 3

  • What are structures 3 and 4 (roll-over image) and why are they denser (whiter) than surrounding soft tissues?
  • 3 = Abdominal aorta
  • 4 = Left kidney
  • They are bright because the scan has been taken shortly after giving intravenous contrast which remains in high concentration in more vascular structures such as these

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

Last reviewed: March 2016