A lucky and reversible cause of 'ischaemic bowel'.
An 81-year-old man was admitted with an infective exacerbation of chronic obstructive pulmonary disease. He also had clinical and radiological features suggestive of ileus. On day 6 after admission, he developed generalised abdominal pain. Urgent computed tomography of the abdomen showed presence of portovenous gas and dilated small bowel with pneumatosis intestinalis and whirl sign. Emergency laparotomy was performed, which showed a 7-mm perforated ulcer over the first part of the duodenum and small bowel volvulus. Omental patch repair and reduction of small bowel volvulus were performed. No bowel resection was required. The patient had a favourable outcome. Clinicians should suspect small bowel volvulus as a cause of ischaemic bowel. Presence of portovenous gas and pneumatosis intestinalis are normally considered to be signs of frank ischaemic bowel. The absence of bowel ischaemia at laparotomy in this patient shows that this is not necessarily the case and prompt surgical treatment could potentially save the bowels and lives of these patients.
Acute Geriatric Unit, Grantham Hospital, Aberdeen, Hong Kong.
Y F
YF
Shea
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
Felix C L
FC
Chow
Acute Geriatric Unit, Grantham Hospital, Aberdeen, Hong Kong.
F
F
Chan
Department of Radiology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
Janice J K
JJ
Ip
Acute Geriatric Unit, Grantham Hospital, Aberdeen, Hong Kong.
Patrick K C
PK
Chiu
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
Fion S Y
FS
Chan
Acute Geriatric Unit, Grantham Hospital, Aberdeen, Hong Kong.
L W
LW
Chu
D000369:Aged, 80 and over; D004381:Duodenal Ulcer / Q000150:complications* / Q000601:surgery; D006801:Humans; D045822:Intestinal Volvulus / Q000150:complications* / Q000601:surgery; D007421:Intestine, Small / Q000098:blood supply*; D007511:Ischemia / Q000209:etiology*; D008297:Male; D010439:Peptic Ulcer Perforation / Q000150:complications* / Q000601:surgery
Abdomen; Intestinal obstruction; Ischemia; Tomography, X-ray computed