DESCRIPTION

A 43-year-old man with a history of viral hepatitis and active intravenous drug use presented with a 4-day history of severe nausea and coffee-ground emesis, followed by acute onset of colicky abdominal pain and non-bloody diarrhoea. On examination, he was tachycardic, but otherwise haemodynamically stable and afebrile. There was tenderness in the right upper quadrant, with no rebound or guarding and bowel sounds were normoactive. Initial laboratory investigations revealed raised urea of 24 mM/L, normal lactate and no leucocytosis. A CT of the abdomen and pelvis with contrast revealed gastric pneumatosis (figure 1) with hepatoportal venous gas (HPVG; figure 2) and signs of parenchymal infarction (figure 3). This prompte