A 65-year-old man with known cirrhosis presents with abdominal pain and distension. CT shows a closed-loop small bowel obstruction with 'whirl sign' of mesenteric vessels. Which feature on CT most strongly indicates bowel ischaemia/strangulation requiring urgent surgery?
- A Pneumatosis intestinalis (gas within bowel wall) with portal venous gas ✓
- B Mild ascites around the distended loops
- C Loop dilatation >3 cm without transition point
- D Valvulae conniventes visible within distended loops
Correct answer: A. Pneumatosis intestinalis (gas within bowel wall) with portal venous gas
Explanation
Pneumatosis intestinalis (intramural bowel gas) with portal venous gas are CT findings that strongly indicate transmural bowel infarction — the gas is produced by gas-forming bacteria invading the infarcted bowel wall and entering the portal venous system. These are pre-perforation or post-infarction signs mandating immediate surgery. The whirl sign indicates volvulus/torsion but alone is not equivalent to gas in the bowel wall. Ascites is non-specific. Valvulae conniventes simply confirm small bowel identity.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.