A 41-year-old man with a recent history of weight loss, reduced appetite and nausea presents with acute abdominal pain.
On physical examination he has abdominal distension without tenderness but pain during deep palpation, Blumberg’s sign is negative and bowel sounds are sparse. The initial radiography findings are shown in figure 1 and his blood test results are shown in table 1.
Table 1 | Blood test results at presentation. Click on the picture to enlarge the table.
At this stage, would you choose to give laxatives and discharge the patient, urgently perform a CT scan or endoscopy, or give a prokinetic, antibiotics, laxatives and monitor the patient every 6h? The correct decision here is to perform a CT scan, which is what the case patient underwent—the findings are shown in figure 2.
Figure 2 | Abdominal contrast-enhanced CT scan with coronal and sagittal reconstructions; images were acquired at portal venous time (about 70 seconds after injection of iodinated contrast medium).
Case Question 1
WHAT IS YOUR CLINICAL DIAGNOSIS AT THIS POINT?
a) Intestinal ischaemia
b) Crohn’s Disease