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From question on page 462

Computed tomography of the abdomen showed diffuse calcifications of the aorta (A in fig 2) and other major arterial branches, with limited progression of the oral contrast to the proximal jejunum only. Far more impressive pathologies however were the dilated loops of small bowel with absence of intravenous contrast enhancement but diffuse pneumatosis intestinalis (air in the bowel wall, arrowheads in right panel) as well as the widespread air in the portal vein system (arrowheads in left panel).

These finding were consistent with massive intestinal ischaemia with diffuse bowel necrosis and venous translocation of gas, in its extent not compatible with life.

The fully alert patient and her family had to be informed about the shortly anticipated death. To rule out a less than fatal degree of intestinal ischaemia, a small diagnostic laparotomy was performed which confirmed the incurable extent of the necrosis. The patient was extubated, obtained best palliative care, and expired after several hours.

Figure 2

 Mesenteric ischaemia announcing death (see text). A, aorta.

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