title: Abdominal pain and two x-rays: spot the difference.
abstract: We present two patients with air found in the right upper quadrant on standard abdominal x-ray. One was diagnosed with pneumobilia and underwent elective surgery for a bilioenteric fistula. The other was diagnosed with portal vein gas and underwent an emergency exploratory laparotomy  at which a superior mesenteric artery embolism was found. The differential diagnostic criteria for pneumobilia and portal vein gas are described. If portal venous gas is found on x-ray in patients with abdominal pain, it is recommended that management is aggressive, meaning an emergency  exploratory laparotomy, because mortality in such cases is approximately 75%.
authors.affiliation: Zabok General Hospital, Croatia.
authors.forename: Z
authors.initials: Z
authors.lastname: Rajković
authors.forename: D
authors.initials: D
authors.lastname: Papeš
authors.forename: S
authors.initials: S
authors.lastname: Altarac
authors.forename: N
authors.initials: N
authors.lastname: Arslani
mesh_terms: D001658:Biliary Fistula / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004617:Embolism / Q000000981:diagnostic imaging*; D004646:Emphysema / Q000000981:diagnostic imaging*; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging; D017538:Mesenteric Artery, Superior; D011169:Portal Vein; D011859:Radiography