José Vilar and Friends Case 6 (Update: Solution!)

Hello friends,

this time we are going to move down into the abdomen. This case was shown to me by my good friend Dr José Vizuete (Hospital Universitario Dr Peset, Valencia) and I think that it shows how we should look at images and use all the information included in them.

This is a 39-year-old woman who presents at the Emergency Room with abdominal pain in two occasions.

First episode

Second episode

What would you suspect and how would you proceed?

Click here for the answer



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    Mar 2019
    DISCUSSION 4 Comments

    4 Responses to : José Vilar and Friends Case 6 (Update: Solution!)

    1. S says:

      Multiple dilated loops of small bowel without air-fluid levels were present both times, suggesting small bowel obstruction (mechanical or adynamic).
      I would search the medical records for any previous surgeries (adhesions) or hernias.

      The comment about using all information available made me take a closer look at the sacroiliac joints, and their margins are a bit indistinct, so I would probably recommend dedicated views of sacroiliac joints and if they would be consistent with sacroiliitis, look into the possibility of inflammatory bowel disease.

    2. José Vilar says:

      There was no history of surgery or trauma. No oncological problems.

    3. Fingers crossed says:

      Distended small bowel loops with Rigler sign suggesting pneumoperitoneum.

    4. Trinity says:

      Abdominal X rays show dilated small bowel loops inthe centre with ill defined mottled gas lucencies in right hypochondrium on both occasions. Large bowel loops are not dilated and return shows air both times. No abnormal radiopaque shadow seen. Soft tissues of bilateral psoas is normal. I would like to do USG abdomen to see for ileocecal thickening.