Case

A 75-year-old patient comes in complaining of abdominal discomfort and have been unable to defecate for 3 days.  They feel bloated with crampy pain from the abdomen.  On physical examination the left lower quadrant is tender to the touch.  

Question 2/4 - What tests would you perform to confirm or rule out your diagnosis?

Click on your selected option(s) below  (correct = 2, over-thinking = 3+)

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Correct! A good option to investigate what might be causing the blockage by examining the interior wall of the colon.

Incorrect. While prompt action should be taken, this has not yet rising to the level of emergency surgery without some sort of information on what and exactly where the obstruction is.

Incorrect. X-ray might show gas pockets from the obstruction, there is insufficient soft tissue resolution or 3D information necessary to plan a course of action.

Correct!  MRI is a good choice for the excellent soft tissue resolution the technique provides.

Possible, but not a first line choice. Although this would provide information, in the absence of oral contrast (which won't work as the contrast won't move along the GI tract with an obstruction) the resolution on soft structures in the bowel make this a sub-optimal imaging modality for this patient.

Incorrect. While not yet an emergency, some additional information is needed before we can risk sending them home.

Incorrect. There is sufficient information in the tenderness evaluation and the depth of the sigmoid colon makes it difficult to palpate. This is unlikely to provide any additional useful information.