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An unusual CT
  1. S Baydar1,
  2. A Hatipoglu1,
  3. A Sezer1,
  4. C Ibis1,
  5. I Coskun1,
  6. H Umit2,
  7. A Tezel2
  1. 1Department of Surgery, Trakya University, School of Medicine, Edirne, Turkey
  2. 2Department of Gastroenterology, Trakya University, School of Medicine, Edirne, Turkey
  1. Correspondence to:
    Dr H Umit
    Gastroenteroloji Bölümü, Trakya Üniversitesi, Tıp Fakültesi, 6 kat, 22030, Edirne, Turkey; hasanumitttnet.net.tr

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Clinical presentation

A 50 year old man was admitted to the emergency room suffering from right upper quadrant pain and vomiting for two days. He had a history of diarrhoea and 10 kg weight loss in the past two months. On arrival, physical examination revealed a distended abdomen with muscular resistance and hypotension. Laboratory data were arterial pH 7.22, white cell count 17 000/μl, and total bilirubin 56.1 μmol/l. Abdominal ultrasound was performed and air images were seen peripherally in the hepatic parenchyma. A computed tomography scan of the abdomen was obtained (fig 1).

Figure 1

 Computed tomography scan taken on admission revealed gas shadows in the hepatic portal venous system.

Question

What is the diagnosis?

See page 249 for answer

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Footnotes

  • Robin Spiller, Editor

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