This is abdominal Xray of a 73 years old male who came to the surgery casualty ward complaining of  severe colicky type abdominal pain particularly in the left lower quadrant,gross abdominal distension and not passing stools and flatus for 1 day .This patient  was on long term use of laxatives for chronic constipation.On examination of his abdomen, It was tympanic and palpable mass found in the Abdomen.
What is the Diagnosis?



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33 comments

  1. Anonymous Says:
  2. toxical megacolon

     
  3. Anonymous Says:
  4. intusseption

     
  5. Anonymous Says:
  6. appendicitis

     
  7. i wanna ask about somethings in history ..

    are there attacks of diarrhea in between the attacks of constipation ?? , bloody stool ??

    and i wanna do colonoscopy ...


    By the way ,
    My diagnosis is , " Cancer colon "

    and all above is for confirmation .. :-)

     
  8. And also i wanna work on a 2nd line ,

    i wanna ask about past vascular problems ..

    as also in old age with a such presentation , i should suspect vascular occlusion ..

    but i think the case is toward Colon cancer ..

     
  9. Anonymous Says:
  10. i agree with "cancer colon"! defenitely colonospocy, and blod results ( red blod cells, hemoglobin, etc)

     
  11. Anonymous Says:
  12. intestinal obstruction , tumor

     
  13. CA Colon

     
  14. zubair Says:
  15. this is Sigmoid volvolus with omega loop apparent on abdominal radiograph.

     
  16. Anonymous Says:
  17. clinical hx suggests large intestinal obsstruction.
    DD list
    He might have chronic constipation due to CA descending colon or sigmoid colon or old age associated with poor dietery habits.He did not have a Hx of per rectal bleeding.So CA can be excluded.
    Adhesions,Sigmoid Volvulus are the other possible DDs.
    Long term of laxative use - megacolon

     
  18. Anonymous Says:
  19. arash from iran
    volvulus

    it is very interesting after your correction of picture name , diagnosis which made by users is different , before correction it was all the same and true diagnosis

     
  20. Anonymous Says:
  21. i would need further examination to make a diagnoses, but as far as you could only tell us this history, i wolud say:Ca colon.

     
  22. Jerry87 Says:
  23. tc scan can revele the diagnosis,ca colon,ischemian,volvolus or irritable colon syndrome

     
  24. go block Says:
  25. i agree with the Ca of colon ..... cause of empirical data for such patien more than 80 % with malignancy.

     
  26. malik Says:
  27. Sigmoid Colon Volvulus

     
  28. Bobbymurjani Says:
  29. i agree with colon sigmoid volvulus because the pain and the mass...

     
  30. Anonymous Says:
  31. why dont you tell us true diagnosis and initiate next case

    which of the above names in comments is webmaster?

     
  32. majd ezzo Says:
  33. Sigmoid volvolus "omega loop"

     
  34. Anonymous Says:
  35. chronic laxative use can lead to dependence, leading to bowel relaxation, therefore further worsening constipation in the long run. also, laxatives can cause colon cancer, in which there would be decrease in the diameter of stools/obstruction in the colon and may be misdiagnosed as functional constipation.

    for this patient i would request for colonoscopy for confirmation, also decompression by inserting NGT to prevent intestinal rupture, which could lead to sepsis.

    if there is already an intestinal rupture, exploratory laparotomy should be done STAT.

     
  36. Anonymous Says:
  37. Ultrasound can also be done to view the mass. the mass could either be fecal stasis or an actual tumor which could be malignant as resulting from laxative overuse.

    always base your diagnosis on the History and PE. Laboratory findings are always secondary. The chronic laxative use was already a giveaway.

     
  38. Anonymous Says:
  39. overuse of laxatives can lead to diarrhea which leads to loss of electrolytes like potassium. hypokalemia would then occur which would alter intestinal motility therefore causing constipation, fecal stasis and retention of gases.

     
  40. Anonymous Says:
  41. sometimes in colon cancer, blood in stool is not always seen grossly. blood in stool can be identified through occult blood. therefore, laboratories would only be confirmatory, but NOT THE BASIS OF THE DIAGNOSIS. History and PE must always be the basis of the diagnosis, not laboratories.

     
  42. Anonymous Says:
  43. sigmoid volvolus

     
  44. a Says:
  45. sigmoid volvolus
    colon diverticulitis

    we need contrast enema

     
  46. Anonymous Says:
  47. 73 yrsold male present with acute large bowel obstruction.(as he complaint for obstipation for just 1 day with abdominal mass).
    for the film,showing the omega sign which has base point to LLQ...suggested sigmoid volvulus.

    he need operation as soon as his status is stable.

     
  48. Anonymous Says:
  49. partial intestinal obstruction..if bowel sounds can b heard.

     
  50. Anonymous Says:
  51. intestinal obstruction due to;
    1.sigmoid volvulous, or
    2.CA sigmoid

    dr sadia

     
  52. Anonymous Says:
  53. toxical megacolon

     
  54. Anonymous Says:
  55. Intestinal obstruction-probably colon cancer. I would recommend CT and after it operation.

     
  56. Anonymous Says:
  57. 1.pseudo-obstruction..
    2.sigmoid volvulus

     
  58. Anonymous Says:
  59. Sohaib from Dow Medical College:

    this AXR shows a large opacity in left lower quardant also large translucency exdending from lower right to upper left quadrant. the opacity can be due to a palpable mass wch was found o/e. precisely my differentials are : CA Colon, Melanosis Coli

     
  60. Anonymous Says:
  61. volvulus

     
  62. Anonymous Says:
  63. sigmoid volvulus
    Positive omega sign

     

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