Plain radiographs of the abdomen are a common first-line imaging study ordered for patients with

abdominal pain. Nonradiologists need to be able to independently identify a variety of different

intestinal pathologies. This radiograph demonstrates several dilated loops of small bowel with a stricture
in the proximal transverse colon. At surgery, this patient was found to have a gangrenous loop of small
bowel from a mesenteric artery embolism.
A patient presents with obvious signs of abdominal discomfort. What process is likely responsible for the
large bowel obstruction in this abdominal radiograph?

The colonic distension is due to fecal impaction. The large bowel can be identified by the haustra and is
distended from the ascending colon through the sigmoid. There is a definite paucity of air in the rectum
caused by impacted feces leading to a buildup of fecal material and gas. This could be confirmed with
anoscopy or manual examination.