Pneumatosis intestinalis

This elderly woman presented with large bowel obstruction. PFA shows dilated bowel as well as evidence of pneumoperitoneum (note the nice examples of Rigler’s sign, yellow arrows). Also present on this x-ray is pneumastosis intestinalis – there is abnormal gas in the wall of the caecum and ascending colon, better seen on the magnified image on the right (white arrows). In this case the pneumatosis was due to bowel ischaemia.