YAR

A 23-year old male university student and collegiate athlete who has been in excellent health was suddenly seized in the midde of the night by a severe attack of “indigestion” accompanied by cramplike pains above and arround the umbilicus. He tried to move his bowels but did not succeed. The next morning, he felt hot and uncomfortable and decided to stay in bed. He had no appetite and some nausea and did not eat anything. By evening the pain had moved to the self lower abdominal region. He consulted the school health service, which transferred him to a hospital.

In the examining room the patient was found lying on his back with his right thigh flexed. He has a slightly increased temperature of 99.60 F, his pulse rate was 94 with shallow respiration. The patient now localizes his pain to the lower right quadrant. On palpation of the abdomen, marked localized tenderness and some rigidity in the right iliac fossa are noted. Pressure with the fingertip shows the area of greatest tenderness is located near McBurney’s point. Intense pain was felt when the thigh was hyperextend, indicating a positive "psoas sign"
ultrasound exams, demonstrated these images :
Your diagnosis please ?

Radiologic indications (2)

A 3 years old boy with imperforated a**s and colostomy is operated for anoplasty.
After successful anoplasty and colostomy closure, a new problem develops. The child passes urine via a**s.
For diagnosing the possible fistula between urinary tract and gastrointestinal tract, which radiologic exam, do you advice?
1- Ultrasound
2- Barium meal
3- CT scan
4- MCU
5- IVU
6- Other modality such as....