On CT scan of a polytrauma patient, the bowel wall shows pneumatosis intestinalis (intramural gas), portal venous gas, and 'shock bowel' pattern (diffuse bowel wall thickening with hyperenhancement). These findings together are MOST consistent with:

• A Mesenteric ischaemia from superior mesenteric artery occlusion
• B Traumatic bowel perforation with peritonitis
• C Diaphragmatic hernia with strangulation
• D Hypoperfusion complex (shock bowel) secondary to haemorrhagic shock ✓

Explanation

The combination of bowel wall thickening, mucosal hyperenhancement, periportal oedema, and flattened IVC (small calibre) describes the 'hypoperfusion complex' or shock bowel seen in profound haemorrhagic shock. Portal venous gas in this context reflects mucosal ischaemia from hypoperfusion rather than bacterial translocation. While mesenteric arterial occlusion causes ischaemia, the full constellation with IVC collapse points to haemorrhagic shock physiology.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.