FINDINGS: Contrast enhanced CT shows complete occlusion of the SMA ~4 cm distal to its origin (nicely demonstrated on the VRT reconstruction) with subsequent pneumatosis intestinalis of large portions of the small bowel and the proximal half of the large bowel. Extensive gas filled tributaries of the superior mesenteric vein are seen. Portal venous gas is also visualised, predominantly in the left liver lobe. Wedge-shaped splenic hypoperfusion dorso-apical consistent with a small splenic infarction. Traces of free fluid down the paracolic gutter on the right.
Secondary findings include atelectatic lung, a 10 mm left lower lobe pulmonary nodule measuring 10 mm in the left lower lobe dorsally, advanced arteriosclerosis and degenerative as well as osteopenic skeletal changes, renal atrophy with a calcified cyst on the right.
CONCLUSION: Fulminant bowel ischaemia due to proximal, thromboembolic SMA occlusion resulting in pneumatosis intestinalis, and extensive portomesenteric venous gas.