PMC3549582_01
Note the marked dilatation of both the cecum and the transverse colon. Also note the presence of air down to the rectosigmoid junction, with no evidence of obstruction. Also visible in this image are the staples from the multiple skin grafts and the Dobbhoff NG tube feed catheter. All patient identifiers have been scrubbed from this image and replaced with random information.
eplasty13e01_fig1.jpg
PMC3549582_01_eplasty13e01_fig1.jpg
F1
A plain abdominal radiograph indicated significant colonic distension, with a cecal diameter of 12 cm with associated air extending to the rectosigmoid junction (Fig 1).
Taken a few hours after neostigmine administration. The reduction in colonic dilatation is clearly visible.
eplasty13e01_fig2.jpg
PMC3549582_01_eplasty13e01_fig2.jpg
F2
A follow-up abdominal x-ray ordered 3 hours later showed near-normal colonic profile, with a cecal diameter of 5 cm (Fig 2).
The red lines in these images represent the generalized normal high and low reference values for our laboratory. Serum albumin levels are not available for this patient. The slight bump in hematocrit, in the middle of the graph, on this patient represents the transfusion of packed red blood cells. The onset of symptoms occurs on or around 3/19/11 in these graphs. The administration of neostigmine occurs on 3/24/11 on these graphs.
eplasty13e01_fig3.jpg
PMC3549582_01_eplasty13e01_fig3.jpg
F3
As is common with large surface area burn patients, this patient was in the operating room for debridement and wound VAC changes every 3 days from admission until the time of this event for a total of 7 operations in that time span. All of her major electrolytes (calcium, magnesium, and phosphate) were low and required nearly daily repletion during the month leading up to her ACPO episode (Fig 3).