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Coronal slice - demonstrating small bowel dilatation.
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Due to failure to settle a computed tomography (CT) was performed that demonstrated multiple transition points, a mass of small bowel loops within the pelvis consistent with adhesional obstruction and no sign of recurrence of colorectal cancer (Fig. 1).
Line graph demonstrating C-reactive protein course.
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C-reactive protein (CRP) rose to more than 200 (Fig. 2). Clinical assessment at this stage led to CT scanning of the abdomen and pelvis that revealed a pelvic collection suggestive of anastomotic leak (Fig. 3).
Sagittal slice - demonstrating pelvic collection.
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C-reactive protein (CRP) rose to more than 200 (Fig. 2). Clinical assessment at this stage led to CT scanning of the abdomen and pelvis that revealed a pelvic collection suggestive of anastomotic leak (Fig. 3).
(1) Line graph demonstrating plasma sodium course. (2) Line graph demonstrating plasma potassium course.
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Bloods performed that day demonstrated acute hyponatraemia with a plasma sodium of 118 mmol/L (Fig. 4(1)), hypocalcaemia (corrected Ca2+ 1.80) and hypermagnesaemia (Mg2+ 1.43). This treatment resulted in a rapid improvement in his electrolyte imbalance (Fig. 4).
Post haemorrhage coronal image.
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CT scanning was performed that demonstrated grossly abnormal adrenal glands bilaterally with rounded masses thought to be haematomas (Fig. 5).