2 Days Of Worsening in Surgery — 62yo Man | General Surgery | SMLE Q#19929
SMLE Question #19929
Surgery
General Surgery
Objective: OBJ-TRACH-EMERG-01
Last updated: May 2026
A 62-year-old man presents to the emergency department with 2 days of worsening abdominal distension, crampy lower abdominal pain, and constipation with no passage of flatus. He reports intermittent similar episodes over the past month. Examination shows a markedly distended, tympanitic abdomen with mild diffuse tenderness and no guarding. Digital rectal examination reveals an empty rectal vault. An upright abdominal radiograph shows colonic dilatation with a maximal transverse colon diameter of 9 cm. Which investigation is most appropriate next?
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