Endgames Spot Diagnosis

Severe abdominal pain in an 85 year old woman

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5749 (Published 16 November 2016) Cite this as: BMJ 2016;355:i5749
  1. Joseph Dalby Sinnott, core surgical trainee1,
  2. David C Howlett, 2 consultant radiologist
  1. 1Department of Surgery, East Sussex Hospitals NHS Trust, Eastbourne, UK
  2. 2Department of Radiology, East Sussex Hospitals NHS Trust
  1. Correspondence to: J D Sinnott j.d.sinnott{at}gmail.com

An 85 year old woman was admitted to hospital with a rigid, mildly distended, severely painful abdomen and absent bowel sounds. She was in atrial fibrillation and was hypotensive. A computed tomography (CT) scan was performed. What does it show (fig 1)?

Fig 1

Answer

The CT scan shows widespread peripheral branching gas within the liver. This is consistent with a diagnosis of portal venous gas, and in this case was secondary to small bowel ischaemia.

Discussion

The non-contrast CT scan (fig 2) shows widespread branching gas that is …

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