Portal venous gas due to small bowel infarction

Case contributed by Chris O'Donnell
Diagnosis certain

Presentation

Severe abdominal pain

Patient Data

Age: 65 years
Gender: Male

Gross portal venous gas filling the entire hepatic portal venous sytem.  Note also gas in the mesenteric veins and wall of the distended small bowel.

Case Discussion

This is an antemortem scan i.e. not one of my postmortem scans. 

This gas is produced by gas-forming organisms that proliferate in the wall of infarcted bowel - this is exactly the same appearance that occurs after death in putrefaction thus this is antemortem putrefaction of the bowel and liver due to infarction.  The condition is universally fatal when seen like this on CT.

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