Twisted

Gastrointestinal System


Step 1: View Clinicals

A 70 year old man presents with worsening pain in the left lower abdomen associated with an absence of bowel movements and passage of flatus for 6 days. He started vomiting just prior to admission.

His surgical and medical histories are unremarkable.


Step 2: Order Relevant Investigations

1. Serum Electrolytes

check

Na+ 135 mEq/l (135 - 145)

K+ 4.2 mEq/l (3.5 - 5.5)

Cl- 101 mEq/l (95 - 105)

2. Full Blood Count

check

WBC/DC: 9,000/mm3 (4,600 - 11,000)

Hb: 14 g/dl (13.8 - 18 g/dl)

Platelets: 320,000/mm3 (150,000 - 450,000)

3. Upright X-Ray Abdomen

check

The X-Ray shows multiple air-fluid levels and dilated loops of large bowel. There is a markedly distended loop of sigmoid colon assuming an inverted U-shape.

4. CT Abdomen & Pelvis

clear

The CT scan shows multiple dilated loops of colon with air-fluid levels and a central 'whirl' sign.

Step 3: Select Appropriate Management

1. Nasogastric tube

check

2. Start IV Fluids

check

3. Start IV Antibiotics

clear

4. Endoscopic decompression

check