Bowel infarction and perforation

Case contributed by Dr Jeremy Jones


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

Patient Data

Age: 55 years
Gender: Female

Distended, gas-filled loops of small bowel. Extensive intramural gas and free gas (Rigler 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 (shown here) had multiple findings:

  • free intraperitoneal gas
  • Rigler sign: confirming the intraperitoneal gas
  • intramural 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
Published: 23rd Oct 2008
Last edited: 13th Aug 2019
Inclusion in quiz mode: Included

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