Resolution
There are multiple small A/F levels and a small loop of distended small bowel. However, there is gas all the way down to the rectum, which was more evident on the second film (not shown).
In this case, one should consider partial bowel obstruction.
While it may be feasible to try to treat the constipation and then repeat the film eight to 12 hours later to see the progression, it would be more prudent to refer for additional evaluation and treatment.
Acknowledgment: Case presented by Nahum Kovalski, BSc, MDCM, Terem Emergency Medical Centers, Jerusalem, Israel.
These cases are among hundreds that can be found in Terem’s online x-ray Teaching File, with more being added daily. Free access to the file is available at https://www2.teremi.com/xrayteach/. A no-cost, brief registration is required.
