Total alimentary canal necrosis: infarction from oesophagus to anus

Description

A middle-aged woman presented with a 12-hour history of generalised abdominal pain and septic. Her medical history included chronic alcoholism and a 40 pack-year smoking history. Laboratory tests revealed raised inflammatory markers and a macrocytosis. There were no liver, renal or clotting derangements, and haemoglobin and platelet levels were within normal limits. Blood gas analysis showed acidaemia and raised lactate. A CT scan of the abdomen revealed pneumoperitoneum, extensive portal venous gas and pneumatosis intestinalis throughout the entire imaged gut—from distal oesophagus all the way to anus—suggestive of complete intestinal necrosis (figures 1–3). The mesenteric arteries appeared patent. The patient rapidly deteriorated and died within 3 hours of admission.

Figure 1

Axial CT image of upper abdomen showing extensive portal gas, pneumoperitoneum (long arrow) and intra-abdominal free fluid (short arrow). Gastric wall intramural gas (pneumatosis) is visible.

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