Bowel ischemia

Case contributed by Heather Pascoe
Diagnosis almost certain


Reduced GCS, collapse with Right NOF. Lactate 11.5. Metabolic acidosis.Abdominal guarding. Respiratory acidosis. Abdominal guarding. ?Ischemia gut

Patient Data

Age: 85 years
Gender: Female

There are multiple thin branching lucencies within the mesentery in the lower abdomen (consistent with intravascular gas. Small gas locule within the SMV. No portal venous gas. The loops of small bowel in the left lower quadrant and pelvis are prominent and there is probable intramural gas.  

No intraperitoneal gas. There is atherosclerosis at the origins of the celiac, superior mesenteric and inferior mesenteric arteries. The celiac and SMA opacify well. The IMA is small in caliber and is only seen proximally. The IVC is flattened consistent with hypovolemia.

Geographic heterogeneous enhancement of the liver. Bilateral simple renal cysts. Contrast within the gallbladder due to vicarious excretion from previous contrast studies.

Comminuted right intertrochanteric and subtrochanteric fracture. 

Case Discussion

Mesenteric and SMV gas and pneumatosis. Findings are consistent with advanced bowel ischemia. The patient was not an operative candidate and passed away a few hours later.

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