CASE #11

Films:

-supine, left lateral decubitus abdomen - barium enema

Hx:	60 year old male with abdominal pain, distention and obstipation

Look at the first two films. Evaluate the gas pattern in similar fashion as in case #10.
In this film , the patient is positioned on his left side with the x-ray beam coursing horizontally through the abdomen. Explain the appearance of the film.
Suggest your diagnosis.
Look at this film , confirm or re-evaluate your diagnosis.
(the oval rectal lucency represents the air filled balloon on the enema tip).

Marked distention of the cecum and ascending colon to the hepatic flexure is present. The bowel folds are thick and widely spaced from one another, indicative of colonic haustra. Gas filled non-distended small bowel loops are seen in the left upper quadrant. No definite colonic gas is seen distal to the proximal transverse colon. Colonic distention and the patient's history indicate a mechanical obstruction.

The barium enema shows abrupt complete obstruction by an annular mass in the recto-sigmoid colon. Generally, the entire colon proximal to the obstruction is gas filled, ie,. in this case we might have suspected a transverse colon lesion. However, not infrequently with low (distal) colonic obstructions, the descending colon is fluid filled accounting for its absence on the plain films. Adult colon obstruction: carcinoma (65%), acute diverticulitis (20%), volvulus (5%), other-hernia, intussusception.

Did you notice the calcifications overlying the symphysis pubis?

These are within the prostrate gland, commonly seen in older males.