Bowel infarction and perforation
Abdominal pain and vomiting. Generalised abdominal tenderness. Involuntary guarding.
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Distended, gas-filled loops of small bowel. Extensive intramural gas and free gas (Rigler's sign).
Initial plain AXR revealed some small bowel distension but the cause was not identified on contrast enhanced CT.
Her clinical course did not improve and she became septic. Subsequent AXR (show here) had multiple findings:
- Free intraperitoneal gas
- Rigler's sign: confirming the intraperitoneal gas
- Intra luminal gas (suggesting infarction)
Subsequent abdominal CT confirmed the above findings and also demonstrated gas in the portal veins within the liver subsequent to bowel infarction.