Description
An 87-year-old man with history of dementia, coronary artery disease on dual antiplatelet therapy and oesophagitis presented to the emergency department with acute-onset coffee ground emesis and left upper quadrant abdominal pain of 1-day duration. Vital signs were normal. Exam was notable for diffuse abdominal pain without peritoneal signs.
Medical work-up was remarkable for haemoglobin of 8.2 g/dL, lactate of 6.3 mmol/L and white blood cell count of 21.84x109/L. CT with angiography of the abdomen and pelvis revealed extensive portal and mesenteric venous gas as well as gastric emphysema (figures 1 and 2). The bowel was normal.
Figure 1
Axial CT image of the upper abdomen with intravenous contrast demonstrates extensive portal venous gas (blue arrow). Multiple locules of gas (red arrows) are present in the wall of the stomach.
Figure 2
Coronal CT of the upper abdomen...
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