Bowel infarction and perforation

Case contributed by Dr Jeremy Jones

Presentation

Abdominal pain and vomiting. Generalised abdominal tenderness. Involuntary guarding.

Patient Data

Age: 55 years
Gender: Female
Modality: X-ray

Distended, gas-filled loops of small bowel. Extensive intramural gas and free gas (Rigler's sign).

Case Discussion

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.

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Case Information

rID: 4846
Case created: 23rd Oct 2008
Last edited: 29th Oct 2016
Inclusion in quiz mode: Included

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