Case 321

Case 321

Medical history

A 20 year-old male patient with non-specified neuropsychomotor development retardation is admitted to the emergency department with respiratory distress, abdominal distension and a 4 week constipation history that did not resolve with home laxative measures. Interrupted flatus passage in the last 24 hours. Digital rectal examination identified a large fecaloma. After being submitted to complementary exams, the patient developed tachydyspnea (40 ripm), tachycardia (140 bpm), confusion and respiratory failure (SpO2 82% while breathing ambient air).

Image 1: Chest radiograph, AP view, patient in dorsal decubitus.

Image 2: Plain abdominal radiograph, AP view, patient in dorsal decubitus.

Image 3: Non contrast-enhanced adbominal and pelvic computed tomography (CT) scan, coronal reconstruction at the level of the coxofemoral articulations.


Question:
After careful consideration of the clinical scenario and imaging exams, what is the most appropriate management option for this patient?

Test question

(Emergency Hospital of Goiânia – adapted question) In a clinical scenario of acute obstructive abdomen, which of the following should be the first imaging exam ordered?

Comentar