Prepared by Nina D. Raoof, MD, Assistant Attending Physician, and Stephen M. Pastores, MD, Director, Critical Care Medicine Fellowship Program, Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York City, NY

An 84-year-old man with Crohn’s disease presented to the emergency department with a rigid, distended abdomen associated with obtundation and respiratory failure requiring mechanical ventilation. A computed tomography (CT) scout film (Figure 1) and a CT scan of the abdomen (Figure 2) are shown.

What’s Your Diagnosis?
Colonic perforation

Small bowel obstruction

Colonic volvulus with mesenteric ischemia

Ogilvie’s syndrome