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Question

Difficulty: EasyGastrointestinal and Abdominal Surgery

Match each acute gastrointestinal surgical condition with its most characteristic initial imaging finding.

  • Perforated peptic ulcerFree air under the diaphragm on upright chest radiograph
  • Complete small bowel obstructionDilated bowel loops with multiple air-fluid levels on upright abdominal radiograph
  • Sigmoid volvulusMarkedly distended bowel loop forming a 'coffee bean' sign on abdominal radiograph
  • Acute cholecystitisGallbladder wall thickening (>3 mm) with pericholecystic fluid on ultrasound

Answer

Perforated peptic ulcer matches with free air under the diaphragm. Complete small bowel obstruction matches with dilated bowel loops and air-fluid levels. Sigmoid volvulus matches with the 'coffee bean' sign. Acute cholecystitis matches with gallbladder wall thickening and pericholecystic fluid.
Correctly identifying these classic imaging findings is essential for the rapid triage and surgical management of the acute abdomen. Each finding is pathognomonic or highly characteristic for its respective surgical condition.

Step-by-Step Solution

1
Identify the classic imaging finding for a perforated viscus.
Free air under the diaphragm on an upright chest radiograph.
Intestinal gas escapes into the peritoneal cavity and rises to the highest point.
2
Identify the classic imaging finding for a mechanical small bowel obstruction.
Dilated bowel loops with multiple air-fluid levels on an upright abdominal radiograph.
Obstruction prevents the distal passage of intestinal contents, causing proximal dilation and separation of gas and fluid.
3
Identify the classic imaging finding for sigmoid volvulus.
A markedly distended bowel loop forming a 'coffee bean' sign.
The twisted, closed-loop segment of the sigmoid colon dilates massively and takes on this highly characteristic plain film appearance.
4
Identify the classic imaging finding for acute cholecystitis.
Gallbladder wall thickening with pericholecystic fluid on ultrasound.
Inflammation of the gallbladder leads to edema (wall thickening >3 mm) and fluid exudation around the organ.

Key Concept

Radiographic hallmarks of acute gastrointestinal surgical emergencies
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Topics

Gastrointestinal and Abdominal Surgery

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