A 72-year-old patient with diarrhoea and abdominal pain

A 72-year-old diabetic male was referred by his general practitioner because of gradually increasing diarrhoea and abdominal pain over several days. On examination, he had mild acidotic breathing, and he appeared slightly dehydrated. The abdomen was distended and tender on palpation. Blood chemistry revealed slight derangement of his diabetes, and a neutrophil count of 12 x 10/l, liver enzymes were slightly elevated (ASAT 60, ALAT 70 U/l). During clinical observation, symptoms worsened, and a plain abdominal radiograph was performed (figure 1).