PMC3350121_01
Supine abdominal radiograph. There is minimal visible bowel gas. Several loops of the small bowel are visible due to the presence of residual barium from a swallow study three days before. Segments in the right lower quadrant are particularly abnormal with the barium forming a dense cast-like appearance (arrows).
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fig1
Plain abdominal radiograph (Figure 1) demonstrates a large amount of fluid within nondistended small bowel which was otherwise relatively gasless.
Abdominal CT scan at the level of the iliac crests demonstrates dense barium opacification of the abnormal right lower quadrant segments of ileum. The loop of small bowel leading into these segments shows increasing wall thickening. Scattered pockets of fluid (arrows) are seen elsewhere.
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fig2
A subsequent abdominal CT scan (Figure 2) again demonstrates the residual barium in the distal ileum which imposes considerable streak artifact.
CT scan through the pelvis at the level of the acetabula demonstrates fluid (F) between the seminal vesicles and the rectum. Dense barium is present dependently within the fluid.
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fig3
Images through the pelvis (Figure 3) reveal a larger fluid collection which contained a small amount of dense barium in a dependent position indicating perforation of bowel.