Presentation
History of vomiting. Abdominal distension. Desaturation.
Patient Data
Bilateral basal atelectasis and small effusions, possibly from
aspiration.
Gallstones.
Moderate dilatation of a substantial number of small bowel loops with
intramural gas strongly suggesting ischemia.
No proximal SMA occlusion.
Intrahepatic gas with some features atypical for biliary gas since it
may be in the portal veins even though none of the branching air
structures can be linked to the contrast filled portal veins.
Case Discussion
This is a case of an elderly nursing home patient who deteriorated shortly after presentation and was palliated for aspiration pneumonia and global ischemic bowel with no prospect of survival.