An 83-year-old man with a history of prostate neoplasia treated with radiotherapy, currently asymptomatic untreated radicular proctitis, hiatal hernia and asymptomatic gastroduodenal ulcus on maintenance treatment with omeprazole 20 mg/24 h, chronic obstructive pulmonary disease and untreated pneumoconiosis, after 40 years of evolution.
He presented to the emergency department with continuous, dull and non-pleuritic pain in the left hemithorax for 24 hours. He maintained his appetite, oral tolerance and daily bowel habits. He reported no previous trauma, surgery or invasive studies. His general condition was good, he was apyretic and haemodynamically stable. He presented a normal neurological, cardiological and abdominal examination; no adenopathies were found. Some isolated bilateral pulmonary rhonchi were auscultated. Electrocardiogram, haemogram, blood count, white blood cell count, coagulation study, glycaemia, ionogram, serial troponins and renal and liver function tests were normal.
Plain chest X-ray showed a bilateral basal reticulo-nodular pattern. Abdominal X-ray showed bilateral pneumoperitoneum, with a small bowel segment in the mesogastrium rectified in the absence of intestinal obstruction.
An emergency thoraco-abdominal computed tomography (CT) scan revealed a small bowel segment with intramural gas dissection of its wall, presence of gas in the subsidiary mesenteric vessels and portal vein, and bilateral pneumoperitoneum.

