72 year old lady complaints of abdominal distension, Constipation, kindly describe the findings.

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Rt sided gas under diaphragm , ? GI perforation with distal small bowel Obstruction ? Pneumoperitonium

Gas under right dome with fluid level. Gas distended intestinal loops with multiple fluid levels. GI perforation with peritonitis.

Intestinal perforation with peritonitis

Sigmoid volvulus, advised first conservative treatment in the form of NBM,Ryle's tube suction continuous, IV fluids maintaining electrolyte balance,Antibiotic, antiinflammatories. If it does not subside in 48 hrs then do exploratry laparotomy and undo the volvulus, if on exploration there is gangrene of gut,then do resection anastomosis and send the specimen for histopathology examination

Megacolon enema

Intestinal perforation

Perforation

Sigmoid volvulus with classical coffe bean appearancd

Intestinal perforation

Coffee bean sign ??? Sigmoid volvulus ??? Multiple air fluid levels seen

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