Pneumatosis intestinalis presenting with acute abdomen.

A woman in her 70s attended the emergency department with sudden-onset severe epigastric pain, abdominal distension and sinus bradycardia of 37 beats per minute. Her relevant past medical history included irritable bowel syndrome, axillary node clearance for breast cancer and surgical removal of an ovarian cyst as a young woman. A CT scan showed pneumoperitoneum and air in the small bowel wall and findings suggestive of volvulus and bowel obstruction. Emergency laparotomy revealed extensive small gas-filled blisters in the submucosa of the mid-small bowel, consistent with pneumatosis intestinalis. Adhesiolysis was performed, and the bowels were inspected thoroughly. No obvious alternative pathology was identified for the patient's symptoms.