Finding-the-Path: Supine and upright abdominal radiographs

Supine and upright plain radiographs of the abdomen show a relative paucity of bowel gas on the left side of the abdomen. There is mild irregularity and thickening of the folds in a loop of bowel in the right lower quadrant (arrow). Several gas-fluid levels are visible in this region (arrows). No appendicolith or free intraperitoneal air is shown. These findings are consistent with an inflammatory process in the right lower quadrant resulting in a localized small bowel ileus.

Which study do you request next?

• CT of abdomen/pelvis
• Ultrasound of pelvis/appendix
• Upper gastrointestinal series
• MRI of pelvis
• Barium enema