A young male with Severe Pain Abdomen

A young male aged 35 years with history of Constipation Chief Complaints Pain Abdomen (Colicky and Non radiating) No passage of Flatus Vomiting since 2 hrs Physical Examination P/A- Distended, Tenderness(+) Epigastrium

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Distended bowel loops seen A case of sub - acute intestinal obstruction- because no air - fluid levels seen A single fluid - level is in stomach . Most likely - impacted faecoliths due to chronic constipation. D/D Volvulus Intestinal tuberculosis Ogilvie syndrome A CECT abdomen will be helpful to locate the site and cause of obstruction Treatment- NPO till the obstruction is relieved . A practoclyss enema if successful will reveal the obstruction. If still not relieved - a colonoscopy can be attempted. Other wise manual disimpaction of faecoliths and evacuation under a short G.A can be attempted

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Fluid level History In favor of peptic ulcer perforation

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Multiple fluid levels are seen with dialated loops Intestinal obstruction SAIO RX CONSERVATIVE

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Distended bowel loops noted. Possibly obstructive etiology.

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Subacute intestinal obstruction Rx. Conservative + proctoclysis enema of possible ........ wait & watch.... CECT abd ......

Collicky pain more suggestive of obstruction rather than peritonitis.

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