Abdominal X-ray - Scenario 3
Answers to scenario questions

Answers to scenario questions

Question 4

What is the radiological diagnosis and what are the possible causes?

• Large bowel obstruction. The most common causes are bowel cancer and strictures due to diverticular disease. Volvulus is a less common cause. Obstruction can also occur at the level of a stoma (as was found to be the case here).

Question 5

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

• In the setting of an acute abdomen an erect chest X-ray should be requested to determine the presence of perforation. (Don't wait to be asked this question. If asked to look at an abdominal X-ray in the context of an acute abdomen you could even begin by asking if there is an erect chest X-ray available to see.)

Question 6

What precautions should be taken before and after performing the CT scan in this clinical setting?

• The patient must be properly resuscitated prior to transfer to the radiology department. He is clinically dehydrated and so it is likely his renal function will not be sufficient to give intravenous contrast material safely. If renal function is impaired then the risks versus benefits of performing a CT with intravenous contrast, which is nephrotoxic, should be considered, usually by direct discussion between a senior clinician and a radiologist.
• The patient must be accompanied by an appropriate level of nursing and medical staff.
• History of previous allergy to intravenous contrast material should be checked.
• Appropriate resuscitation and monitoring of renal function must continue after the scan.