Bowel ischemia with portal venous gas

Case contributed by Assoc Prof Craig Hacking

Presentation

Two days of worsening abdominal pain. Extensive cardiac history, recent non-STEMI. For cardiac angiogram.

Patient Data

Age: 75 years
Gender: Male

Extensive portal venous gas within both lobes of the liver especially the right and the medial aspects of the left lobe. Extensive gas within the branches of the portal venous system outside the liver.

Dilated loops of small bowel with transition point within the right lower quadrant near the terminal ileum, which is collapsed. The dilated small bowel loops contain intramural gas. No evidence of pneumoperitoneum. Small amount of free fluid within the right iliac fossa.

Enlarged lymph node anterior to the celiac trunk measuring 14mm. No further CT significant lymphadenopathy. Atheromatous arterial disease is longstanding. Generalized edema of the subcutaneous tissues.

Bilateral pleural effusions, larger on the right with adjacent compression atelectasis.

IMPRESSION

Gas within the portal venous system and small bowel findings are concerning for small bowel ischemia. No evidence of filling defects within the major aortic branches. Urgent surgical review recommended.

Case Discussion

The patient underwent emergency laparotomy that revealed segments of distal small bowel and cecal infarction which were resected. Despite this the patient developed multi-organ failure, sepsis, required multiple relook laparotomies and end ileostomy. The patient died 3 weeks after the initial presentation.

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Case information

rID: 75158
Published: 22nd Mar 2020
Last edited: 22nd Mar 2020
Inclusion in quiz mode: Included

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