Presentation
Overseas worker with chest x-ray for breathlessness. Chest x-ray led to AXR and then CT due to concerns of a bowel perforation.
Patient Data
Grossly dilated large bowel from ileocecal junction to anal verge.
No transition point. No bowel mass.
No pneumoperitoneum.
Case Discussion
Chronic large bowel pseudo-obstruction is chiefly a diagnosis of exclusion and typically one made with interval imaging.
The large bowel is grossly dilated with obstruction or perforation. In this case a medical fitness chest x-ray for employment purposes performed 5 months prior was identical with sub-diaphragmatic large bowel dilatation despite the patient being asymptomatic and working as a hard laborer.
The large amount of gas under the diaphragm on chest x-ray causes concern in the unaware of a perforation and is one cause of a pseudopneumoperitoneum.
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