Elderly patient on medical ward with vague tummy pain.
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Ischemic bowel with perforation:
- pneumoperitoneum with falciform ligament illustrated
- intramural gas
- portal venous gas and gas in SMV
- non-enhancing bowel
- peritoneal free fluid
Textbook example of the very extreme side of the spectrum of CT findings in acute intestinal ischemia.
The classic features are present:
- Portal venous and SMV gas: see the air-contrast level in the SMV.
- Multiple loops of bowel with intramural air
- Non enhancing bowel
and in this case a perforation has occurred.
The patient deceased within 10 hours of the CT study.