An 84-year-old man complained of acute sharp abdominal pain, fever and coffee ground vomiting. He was brought to our emergency department for conscious disturbance with hypotension (blood pressure 85/43 mm Hg). Physical examination revealed diffuse abdominal tenderness and distention. Haemogram showed leukocytosis with left shift. Plain film of the abdomen showed diffuse dilated small bowel loops. Bedside abdominal ultrasonography demonstrated circular hyperechoic foci (arrows) in the oedematous bowel wall (hypoechoic ring) of the right abdomen (fig 1A). Abdominal computed tomography (CT) revealed a massive circumferential and band-like air formation as intestinal pneumatosis (arrows) and pronounced oedema of mesenteric fat (arrowhead) around the necrotic bowel loops (fig 1B). Another slice of the abdominal CT showed long segmental pneumatosis of the small bowel (fig 1C). At laparotomy, an adhesive band with small bowel strangulation leaded to ischaemic bowel was discovered.

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Figure 1 (A) Beside abdominal echogram showed intestinal pneumatosis. (B, C) Computed tomography revealed diffuse ischaemic bowel.

CT is the preferred instrument for diagnosing ischaemic bowel. The advantages of ultrasound are non-contrast, low cost and easy availability.1 Our case illustrated the value of ultrasound in ischaemic bowel.