Intended for healthcare professionals

Endgames Spot Diagnosis

Sudden onset abdominal pain

BMJ 2018; 362 doi: (Published 30 August 2018) Cite this as: BMJ 2018;362:k2945
  1. Rupali D Shah, core surgical trainee1,
  2. David Howlett, consultant radiologist, honorary clinical radiology professor12 3
  1. 1KSS Deanery
  2. 2East Sussex Healthcare NHS Trust
  3. 3Brighton and Sussex Medical School
  1. Correspondence to R Shah rupali_shah34{at}

A 48 year old woman attended the emergency department with a sudden onset of severe abdominal pain, worsening over the few hours before presentation. She underwent a computed tomography scan for further assessment. An axial section through the pelvis is included (fig 1). What radiological sign is present?

Fig 1


Multiple dilated bowel loops of small bowel are seen in the pelvis, with extensive bubbles of air seen within the bowel wall (fig 2, arrows). This sign is known as pneumatosis intestinalis. Most cases occur in the jejunum and ileum. A small number involve the colon12 (pneumatosis coli).3 The left side is more commonly affected than the right.2

Fig 2

Arrows point to extensive …

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