Acute Abdomen, Peritonitis, and Intra-Abdominal Abscesses — WACS Viva & Clinical Scenarios (Gastrointestinal and Abdominal Imaging)

Exam-style acute abdomen, peritonitis, and intra-abdominal abscesses viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: Long Case / Film Reading Station (Emergency MDCT): A 24-year-old male with a two-week history of step-ladder pyrexia, headache, and sudden severe lower abdominal pain with peritoneal signs presents to the emergency department. Review the unenhanced and contrast-enhanced portal venous phase abdominopelvic CT scans. Formulate a structured radiological report identifying the primary site of hollow viscus perforation, distinguishing features between typhoid enteric ileal perforation and gastroduodenal peptic ulcer perforation, and characterize associated peritoneal and mesenteric changes.
• SCENARIO 2: OSCE / Viva Station (Emergency Ultrasound and CT): A 19-year-old female presents with right lower quadrant abdominal pain, guarding, rebound tenderness, and leukocytosis. Review the graded-compression ultrasound images and axial/coronal contrast-enhanced CT slices. Provide the diagnostic imaging criteria for acute appendicitis, assess for signs of perforation and loculated periappendiceal phlegmon or abscess formation, and describe the differential diagnoses in a female of reproductive age.
• SCENARIO 3: Clinical Image Reporting Station (Cross-Sectional Imaging): A 62-year-old female presents with severe left lower quadrant pain, fever, and leukocytosis. Contrast-enhanced CT of the abdomen and pelvis demonstrates segmental sigmoid colonic wall thickening, pericolic fat stranding, focal extraluminal air bubbles, and an adjacent 4.5 cm thick-walled, rim-enhancing fluid collection. Interpret these CT findings, assign the correct Hinchey classification stage, and outline the radiological criteria that differentiate uncomplicated diverticulitis from perforated diverticulitis requiring intervention.
• SCENARIO 4: Oral Reporting and Interventional Procedure Station (Image-Guided Drainage): A 48-year-old male on postoperative day 8 following exploratory laparotomy develops spiking fevers, right upper quadrant pain, and leukocytosis. Contrast-enhanced CT reveals a 7 cm multiloculated, rim-enhancing fluid collection in the right subphrenic space with gas-fluid levels. Describe the step-by-step radiological assessment, ultrasound or CT access pathway planning, interventional drainage technique using the Seldinger method, contraindications, and potential procedural complications.
• SCENARIO 5: Plain Radiograph Interpretation and Emergency Triage Station (Rapid Film-Reading): Review an emergency series of upright chest and plain abdominal radiographs (erect, supine, and left lateral decubitus projections) from three acute abdominal presentations. Identify the distinct plain radiographic signs of pneumoperitoneum (including subdiaphragmatic free air, Rigler double-wall sign, football sign, falciform ligament sign, and telltale triangle sign) and specify when cross-sectional imaging is mandatory to determine the perforation etiology.