Abdominal clonic splash

Specialty: Gastrointestinal.

• Abdominal squelching noises
• borborygmi with liquid component
• succussion of intestinal loops

Why it occurs

• Advanced mechanical obstruction of the small intestine with large accumulation of fluid and gas in the proximal loops
• Advanced paralytic ileus of any etiology with stasis of intestinal fluids
• Blind loop syndrome with massive bacterial overgrowth and stagnation of enteric secretions
• Severe bacterial gastroenteritis with fluid hypersecretion and reflex segmental paralysis.

Initial workup

Abdominal x-ray standing and recumbent (presence of wide air-fluid levels or "pile of coins" handles) | CT of the abdomen and pelvis with intravenous contrast (to specify the exact transition point and rule out ischemia or loop perforation) | General analysis with electrolytes, kidney function and serum lactate.

Standard management

• Aggressive intravenous fluid therapy — Ringer's lactate or physiological saline for volume replacement according to losses
• Nasogastric tube placement — for decompression and drainage of accumulated liquid
• Systemic empirical antibiotic therapy if there is suspicion of vascular involvement of loops or associated peritonitis (piperacillin/tazobactam 4.5 g IV every 6 hours).