1 / 3
- Air in retroperitoneum and mediastinum
- Fluid and air dilated duodenum, readily connected to the pylorus on all views. All jejunal loops normal size.
- Duodenal mechanical obstruction
- Pneumomediastinum and pneumoretroperitoneum; cause indeterminate (presumably Macklin effect from severe vomiting)
- Surgical emergency (based on signalment, neoplastic causes are very unlikely, so staging the abdomen unnecessary)
- Stage causes of pneumomediastinum with thoracic radiographs
- Candidates consistently misdiagnosed the duodenum as the colon.
- 50% of candidates never mentioned the word “duodenum” and stopped at testing for causes of pneumoretroperitoneum and pneumomediastinum
- 25% of candidates discussed the challenge of differentiating between duodenum and colon and tested appropriately for differentiating between colon and duodenum (pneumocolonogram, Abd US) receiving partial points.
- 25% of candidates labelled the dilated loop as duodenum, therefore proceeded to surgery to receive full points.