Radiology Quiz No 2
A young lady in her early 20s, who became paraplegic from her mid chest and below from a motor vehicle accident, was admitted for sudden colicky abdominal pain and a grossly distended abdomen. She had difficulty passing motion since her injury and opens her bowel almost once every week. This present episode has occurred before but not as severe as this present presentation. She noticed some changes in her bowel habit since 3 months ago. On examination, she had a grossly distended but soft abdomen and per rectal examination reveals a mass compressing the rectum from above. So, what is this mass?
Note: The importance of complete history taking and the falls of making assumptions. I have left out a few things in the history which you can ask? Happy Guessing!
August 5th, 2007 at 5:25 pm
To imitate my American friends..
OMG!!!!!
Hope your radiographers and radiologist don’t get sued. And hope you don’t get sued for neglecting such important history.
Or should I rather say, ‘Typical surgeon, doesn’t think before he acts.’
I won’t reveal your surprise. I’ll wait for you to deliver the googly and surprise the others
August 5th, 2007 at 5:34 pm
It was actually ordered by the ED doctors! On asking them, they claimed they asked, she denied and they assumed that she told the truth because of her condition. Shockingly, they did not pick it up either! It was on of the surgeons who asked for the information and because of a case I had before, refuse to believe her and insisted that she told us the actual story! She revealed all later!
August 6th, 2007 at 9:36 am
Now promise not to laugh George, but is she pregnant? I said no laughing! OK, slinking off to the next post.
August 6th, 2007 at 5:51 pm
JMB, I think you missed your calling.
Would you like a part-time job reporting x-ray films?
You can report some of the stuff that I don’t have the time to do
August 12th, 2007 at 9:24 am
Wow JMB, excellent! Yes, she is pregnant. That is a fetus in her womb! She was in total denial until we presented to her with her urine pregnancy test. She then cried and agreed that she knew about her pregnancy earlier. Her boyfriend, also a paraplegic on a wheelcair was happy but she was not.
This is my second case of pregnancy involving bed-ridden females. The first managed to deliver vaginally and is still alive, and this is the second.
Then again the issue is never take for granted that a lady is not pregnant even if she claims to have a regular menstrual cycle. A urine pregnancy test is warranted whenever it pregnancy could be a possible cause to the presenting problem.
August 12th, 2007 at 2:43 pm
I can very much understand her not being happy. It’s difficult enough learning to take of one’s self after becoming paralyzed.
This story hits home for me because on June 3rd, one of our great-nieces was paralyzed to a similar degree. The thought has occurred to me that she will likely never have the joy of having her own children. Though I realize that it is probably possible, it is unlikely.
And, then, raising a child when one is in a wheel chair! A brother-in-law, paralyzed 30 years ago, able to use his arms, but with limited use of his hands, later married a very nice lady with a young daughter, who he legally adopted as his own. His wife was later killed in a car accident in which the daughter survived. There were a lot of very trying times, which I won’t go into here.
August 13th, 2007 at 5:19 pm
Hmm…I’m no medical practitioner…just someone who dives a lot…but by looking at the set of vertebraes albeit mini version to the right of the x-ray film tells me the woman is pregnant.
August 14th, 2007 at 1:00 am
it is easy to comment in retrospect. This Xray should not have been done if only they did an urine pregnancy test. The doctors were looking for the cause of intestinal obstruction for which her symmpoms were for.