Perforated, malignant large bowel obstruction due to caecal distension and venous ischaemia
Abdominal pain and distension. Nil passage of flatus, ? bowel obstruction
Patient unwell so no IV or oral contrast
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Distension of the colon to the sigmoid with abrupt transition to collapsed rectum. Irregular mass in the sigmoid is probably cancer although a diverticular stricture is possible. Gross caecal dilatation with swollen irregular, gas-filled mucosa is compatible with ischaemia (probably venous due to luminal distension) and free gas indicating perforation, although the site of perforation is not identified.