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.

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?