Presentation
Sudden onset epigastric abdominal pain with associated vomiting. Previous cholecystectomy and pancreatitis.
Patient Data
Substantial amount of free intraperitoneal gas, mainly located anteriorly in the upper abdomen and most prominent in the right upper outer quadrant where it extends into the perihepatic spaces and hepatic fissures.
Substantial bowel wall thickening in the mid abdomen which most likely is located in the transverse colon extending proximally to reach the hepatic flexure region.
Mottled gas in relation to the left side of the transverse colon may be intraluminal but could indicate extraluminal gas within the transverse mesocolon.
Mild diverticular disease is noted in the sigmoid colon. No other abnormality is evident in relation to the bowel or peritoneal cavity. There is no evidence of free intraperitoneal fluid.
Case Discussion
Patient underwent emergency laparotomy which repaired a large perforation of the distal transverse colon into the lesser sac.
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