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Difficulty: EasyGastrointestinal and Abdominal Surgery

Match each classic radiographic finding with its most likely surgical gastrointestinal diagnosis.

  • Pneumoperitoneum (free air under the diaphragm) on upright chest x-rayPerforated viscus
  • Dilated bowel loops with multiple air-fluid levels on upright abdominal x-raySmall bowel obstruction
  • "Apple-core" lesion on barium contrast enemaColorectal carcinoma
  • "Coffee bean" sign on plain abdominal radiographSigmoid volvulus

Answer

Pneumoperitoneum matches with perforated viscus; air-fluid levels match with small bowel obstruction; apple-core lesion matches with colorectal carcinoma; and coffee bean sign matches with sigmoid volvulus.
Each radiographic finding is a pathognomonic presentation of a specific surgical pathology. Recognizing these straightforward classic signs is a foundational skill for diagnosing common acute abdominal emergencies.

Step-by-Step Solution

1
Identify the cause of free intraperitoneal air.
Free air under the diaphragm implies a hole in the gastrointestinal tract, confirming a perforated viscus.
Intraluminal gas escapes into the peritoneal cavity and predictably rises to the highest point when the patient is upright.
2
Analyze the finding of dilated loops with air-fluid levels.
This is the classic presentation of a small bowel obstruction.
Peristalsis continues against a mechanical block, leading to fluid and swallowed air pooling and layering proximally.
3
Correlate the focal narrowing on barium enema.
The 'apple-core' appearance represents colorectal carcinoma.
Circumferential tumor growth narrows the colonic lumen, which is outlined by the barium.
4
Evaluate the enlarged, U-shaped bowel shadow.
The 'coffee bean' sign indicates a sigmoid volvulus.
The sigmoid colon twists on its mesentery, creating a closed-loop obstruction that massively dilates with gas.

Key Concept

Radiographic hallmarks of acute surgical gastrointestinal diseases
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Topics

Gastrointestinal and Abdominal Surgery

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