Bowel infarction and perforation


Initial plain AXR revealed some small bowel distension but the cause was not identified on contrast enhanced CT.

Her clinical course did not improve and she became septic. Subsequent AXR (shown here) had multiple findings:

  • free intraperitoneal gas
  • Rigler sign: confirming the intraperitoneal gas
  • intramural gas (suggesting infarction)

Subsequent abdominal CT confirmed the above findings and also demonstrated gas in the portal veins within the liver subsequent to bowel infarction.