Picture Quiz: Cochlear bowel

Case history

A 72 year old man presented at the accident and emergency department with a one day history of diffuse colicky abdominal pain associated with abdominal distension and constipation. There was no associated vomiting. Abdominal examination revealed generalised distension without peritonism and increased bowel sounds. There was an operative scar in the right groin from a previous inguinal herniorrhaphy. Figure 1 shows the abdominal x ray film.

Questions

• (1) What is your diagnosis?

• (2) How would you manage this condition?

Answers

• (1) The history and examination suggest bowel obstruction. The presence of …