Clinical presentation

A healthy 81 year old man was referred to us for acute bowel obstruction. The patient did not have a history of chronic illness and was not taking any medication.

On admission, the patient had diffuse abdominal pain, vomiting, and no bowel movements for 24 hours. There was no fever. Clinical examination showed abdominal distension without any contracture or palpable mass. Laboratory data were as follows: leucocyte count 11000/mm³ and haemoglobin level 15 g/dl. C reactive protein concentration was increased to 235 mg/l. Hepatic function tests and amylasemia were normal. Abdominal x ray showed small bowel distension with hydroaeric levels (Image 1). Small bowel barium through enema was performed and the results are shown below.

Question

What does this x ray show?

See page 979 for answer

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