Case 20


A 21-year-old lady with a past history of developmental delay and mental retardation is admitted for coffee ground vomiting. She has had multiple readmissions for a similar problem. She has normal bowel motions and flatus. There is no other significant past medical history.

Physical examination

Afebrile, pulse 72 bpm, BP 115/80mmHg, SaO2 98-100% on RA.

Hydration is satisfactory.

Examination of the hands reveals no clubbing and normal-appearing palmar creases.

Head and neck examination is unremarkable.

Cardiovascular: HS dual, no murmur.

Her chest is clear on auscultation.

Abdominal examination reveals a distended abdomen, but no frank peritoneal signs could be elicited. Bowel sounds are sluggish.

No signs of oedema.



WBC 9.9 x 109/L;

haemoglobin 13.1g/dL;

platelets 289 x 109/L.

Electrolytes are grossly normal.

Bone profile is normal.

Amylase 113 IU/L.

pH 7.43.

BE -2.

sTSH 3.78mIU/L.

An abdominal X-ray is also performed (Figure 20.1).


Please describe what you see

There are markedly dilated large bowel loops.

What is your differential diagnosis?


Large bowel intestinal obstruction.

Colonic volvulus.


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Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 20

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