Presentation
Diabetic with lethargy, abdominal pain and vomiting for 5 days. Dehydrated and confused with a tender abdomen
Patient Data
No free air under the hemidiaphragm. Cardiomegaly and sternotomy wire in keeping with prior mitral valve repair. Patchy bilateral ground-glass opacification within the lungs. Gas-filled central loops of the small bowel.
Complete thrombosis of the superior mesenteric artery with paper-thin bowel, non-enhancing mucosa, mesenteric and portosystemic gas. Background extensive atherosclerotic disease with mural thickening and calcification. Mitral valve repair but no cardiac mural thrombus. Incidental gallstones and left basal atelectasis.
Case Discussion
The case demonstrates acute mesenteric infarction secondary to superior mesenteric artery thrombosis in a diabetic patient with underlying atherosclerotic disease. The pneumatosis portalis is an ominous sign which is associated with a poorer prognosis. The patient subsequently succumbed to the illness.