In colonic pseudo-obstruction, abdominal radiographs typically show which finding?

• A. Free Intraperitoneal Air
• B. Periappendiceal Fat Stranding
• C. Dilated Colon With Air-Fluid Levels Without a Mechanical Obstruction
• D. Normal Bowel Gas Pattern

Answer: (C)

Colonic pseudo-obstruction is a functional delay in colonic motility that mimics a blockage but without a physical obstructing lesion. On abdominal X-ray you typically see a markedly dilated colon with air-fluid levels, yet there is no discrete transition point or distal point where the bowel becomes non-dilated—i.e., no mechanical obstruction. This pattern distinguishes it from true mechanical obstruction, which would usually show a recognizable point of blockage or other signs of a physical barrier. Other findings listed would point to different issues: free intraperitoneal air suggests perforation; periappendiceal fat stranding suggests appendicitis; a normal bowel gas pattern wouldn’t explain a pseudo-obstruction. So the hallmark radiographic finding is a dilated colon with air-fluid levels in the absence of a mechanical obstruction.