Chronic large bowel pseudo-obstruction

Case contributed by Dr Ian Bickle

Presentation

Overseas worker with chest x-ray for breathlessness. Chest x-ray led to AXR and then CT due to concerns of a bowel perforation.

Patient Data

Age: 35
Gender: Male
CT

Plain films not available

Grossly dilated large bowel from ileocaecal junction to anal verge.

No transition point.  No bowel mass.

No pneumoperitoneum.

Case Discussion

Chronic large bowel pseudo-obstruction is chiefly a diagnosis of exclusion and typically one made with interval imaging.

The large bowel is grossly dilated with obstruction or perforation.   In this case a medical fitness chest x-ray for employment purposes performed 5 months prior was identical with sub-diaphragmatic large bowel dilatation despite the patient being asymptomatic and working as a hard labourer.

The large amount of gas under the diaphragm on chest x-ray causes concern in the unaware of a perforation and is one cause of a pseudopneumoperitoneum.

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Case information

rID: 43181
Case created: 26th Feb 2016
Last edited: 20th Mar 2016
Inclusion in quiz mode: Included

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