From nursing home with diarrhoea and vomiting.
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Significantly distended loops of small bowel are demonstrated within the abdomen and pelvis with curvilinear lucencies surrounding several loops of dilated small bowel in the right side of the abdomen, in keeping with pneumatosis intestinalis. Several pockets of gas are demonstrated, one in the right iliac fossa and the other in the left side of the mid abdomen, which are non-specific and may represent free gas. An air fluid level beneath the left hemidiaphragm on the erect film is also non-specific but may represent a dilated stomach.
No significant gas and fecal material is clearly identified within the colon.
Surgical clips are seen projected over the lower abdomen and pelvis.
Dilated small bowel with evidence of pneumatosis intestinalis and features suspicious for free intraperitoneal gas.
2 case question available
Pneumatosis intestinalis has numerous causes, from being benign and incidental through to being pre-morbid. Review of previous imaging and discussing cases with referrer +/- CT is always worthwhile.