A female aged 94 years with a history of diabetes presented with acute onset abdominal pain, haematemesis and altered mental status. She denied alcoholism, corrosive ingestion, pancreatitis or abdominal trauma. She appeared toxic and was hypotensive. Her hemogram showed leucocytosis at 14.8 x 10^9/L. CT scan of the abdomen showed air scattered within the liver, portal vein and gastric wall (figures 1 and 2). Also, dense calcifications of the aorta and abdominal arteries were noted (figure 3). Due to the high risk of surgery, she was managed conservatively with proton pump inhibitors, broad-spectrum antibiotics, nasogastric decompression and intravenous hydration, with progressive improvement noted.
Figure 1
Axial CT scan of the abdomen and pelvis without contrast showing air within the portal vein (white arrows) and in the stomach wall (black arrow).
Figure 2
Coronal CT scan...
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