Questions: A 56-year-old patient reported to the emergency department with colicky abdominal pain in the upper right quadrant, distention, and vomiting. The medical history includes recent blood in the stool, chronic constipation, and smoking. What could a computed tomography (CT) scan of the abdomen reveal related to this intestinal obstruction?

The answer is the first one: Carcinoma in the colon.

Explanation for each option:

1. Carcinoma in the colon: This is a plausible cause of intestinal obstruction, especially given the patient's symptoms of colicky abdominal pain, distention, vomiting, and recent blood in the stool. Carcinoma can lead to a blockage in the colon, causing these symptoms.

2. Volvulus in the sigmoid colon: While volvulus (twisting of the intestine) can cause obstruction, it typically presents with symptoms of acute, severe abdominal pain and distention. The location of the pain in the upper right quadrant makes this less likely, as volvulus usually affects the sigmoid colon, which is located in the lower abdomen.

3. Adhesions around the terminal ileum: Adhesions are bands of scar tissue that can form after surgery or inflammation and can cause obstruction. However, the patient's history does not mention any prior surgeries or conditions that would lead to adhesions, making this less likely.

4. Adynamic obstruction of ileus: Ileus is a condition where there is a lack of movement in the intestines, leading to obstruction. It is usually associated with generalized abdominal pain and distention rather than localized pain in the upper right quadrant. Additionally, ileus is often related to recent surgery, medications, or severe illness, none of which are mentioned in the patient's history.

Summary: Given the patient's symptoms and medical history, a CT scan of the abdomen could reveal carcinoma in the colon as the cause of the intestinal obstruction.