A 32-year-old woman presented with chronic abdominal pain for 1 month. Plain films of acute abdomen series were done. 

Questions

1. Please describe positive findings of the films 

2. What is the provisional diagnosis?

by Dr.Kritchanont Ruamsuph, MD Internist, B.Care Medical Center

ANSWERs

1. Positive findings the films 

• CXR PA upright:  normal CT ratio, full inspiration, no abnormal infiltration, no free air under dome of diaphragm, bowel dilatation at RUQ area with air fluid level
• Films of abdomen supine & upright:  bowel dilatation with air fluid level, predominate at middle and LUQ, present air in the small bowel

2. Provisional diagnosis:  Gut obstruction

• The patient was sent to surgery. Intraoperative findings were consistent with gastric vulvulus. 

โดย ร.ท.หญิง รัชนก  สรรพวัฒน์ อาจารย์หน่วยอายุรศาสตร์โรคระบบทางเดินอาหาร กองอายุรกรรม โรงพยาบาลภูมิพลอดุลยเดช พอ.