Case 75

 An eighty two-year-old female came to our hospital for vomiting and constipation. She felt tasty during eating but much food ingestion induced vomiting. She usually had food once a day. After eating, she usually lies down which is more comfortable than sitting. She had received surgical appendectomy in the past. Seven years ago, she underwent laparotomy under diagnosis of postoperative ileus. Never the less, she has experienced ileus three times since the laparotomy.Ileus tube was inserted each time. Blood pressure 100/50 mmHg, pulse 105/min. Laboratory test revealed CRP 4.91 mg/dL, white blood cells 7080/mm³, neutrophils 85.4 %, Procalcitonin 1.30, Na 134 mEq/L, K 3.4 mEq/L. She received abdomen radiograph (Fig. 1) and abdomen CT for further investigation (Figs. 2, 3, 4).

What is imaging diagnosis based on patient history and abdomen radiograph and CT ?

1. Adhesive ileus

2. Strangulation ileus

3. Hirschsprung disease

4. Chronic intestinal pseudo-obstruction

5. Obstructive ileus

answer

2017.10.11