An elderly lady with a complex abdominal surgical history presented with what seemed to be a 2 day history of obstruction - vomiting, distension, and severe abdominal pain. Allowed in these circumstances, see below the AXR.
What 3 important findings can you see?
The air in the hepatic portal system is a VERY bad sign. Traditionally, hepatic portal air seen on the AXR carries a 75% mortality. In this case there is air in the wall of the stomach (as seen above) and all the way down the intestine. This is most likely from ischaemia (she had a high lactate and WCC) although there are other causes and management depends on the underlying cause. There can be non-fatal causes, but they are rare.
The Derrifoam Blog
Welcome to the Derrifoam blog - interesting pictures, numbers, pitfalls and learning points from the last few weeks. Qualityish CPD made quick and easy.....