LAUSR

managed conservatively and a repeat computed tomography scan 6 days later demonstrated complete resolution of the findings (Fig. 1b). He was subsequently discharged well. HPVG is a rare radiological entity, often co-existing with pneumatosis intestinalis. It is associated with multiple intra-abdominal conditions of widely varied clinical significance, from potentially catastrophic intestinal ischaemia to several benign conditions. We are aware of two reports of HPVG in the literature as an early complication of PEG insertion. In these cases, it heralded the onset of septic shock, multi-organ failure and subsequent death, this was attributed to peritonitis secondary to PEG site leakage in both cases. The striking radiological imaging in our case raised concerns about PEG site leakage and/or intestinal ischaemia. This presented a challenging scenario similar to that of Toh et al., our management of the patient according to his clinical state was vindicated by the good clinical outcome achieved.