Figure 1.
Figure 2.

The patient is a 52-year-old tourist who presents with a four-day day history of abdominal pain, constipation, not passing gas, and nausea. The patient was not comfortable but was hemodynamically stable. Temperature was normal, pulse was 94, BP was 195/99.

The abdomen was markedly distended. WBC was 11.
View the x-rays taken (Figure 1 and Figure 2) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Clinical Challenge: October, 2007

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services
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