Case 218

Case 218


Male 32 years old patient attends the emergency department with reports of vomiting , abdominal pain the ceasing of flatus and feces elimination for two days. He reports preserved diuresis. Physical examination: Dehydrated; distended abdomen with diffuse tenderness and voluntary defense, with no signs of peritonitis; rectal examination showcasing normal sized prostate. Assessment: blood count, liver function, amylase and lipase within the reference margins, creatinine: 6.71 mg/dL ; urea 70 mg/dL. A chest X-ray was requested, showing no alteration, and abdominal radiography was performed (Image 1), as well as the exam in Image 2.

Image 1: Abdominal radiography in supine position.


Image 2

Considering the clinical history and images, which is the most likely diagnosis?