Presentation
Abdominal pain and distension.
Patient Data
Diffuse large bowel dilatation with gradual transition point at the splenic flexure. No mass or bowel wall thickening at this region. The large bowels distal to this are within normal caliber.
Distal small bowels are mildly dilated. Terminal ileum is not thickened. Proximal small bowels are not dilated. No pneumoperitoneum or intramural gas.
No whirlpool sign of the mesentery to suggest volvulus.
Incidental findings of cholelithiasis and right adrenal lipomatous nodule.
Case Discussion
This patient had acute symptoms of abdominal pain and distention with marked large bowel dilatation seen on abdominal radiograph. However, CT scan showed no evidence of mechanical obstruction suggestive of colonic pseudo-obstruction (Ogilvie syndrome).
Patient was treated with neostigmine and colonoscopic decompression. No mass was seen on colonoscopy, confirming the diagnosis of pseudo-obstruction. He recovered well post decompression.
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