X-ray
What is the pertinent finding?
Gas within the small bowel wall (pneumatosis intestinalis) most prominent in the RUQ.
What does most likely represent?
In the clinical context, ischaemic gut would be the most concerning cause.
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 faecal material is clearly identified within the colon.
Surgical clips are seen projected over the lower abdomen and pelvis.
Conclusion
Dilated small bowel with evidence of pneumatosis intestinalis and features suspicious for free intraperitoneal gas.