Patient presented to emergency department with acute onset abdominal pain and distension. No history of any co-morbidities.
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Coronal reformatted images show dilated small bowel loops, with few loops in the pelvis showing rounded cystic collections of air both in dependent and non-dependent portions, suggestive of air in the bowel wall (pneumatosis intestinalis).
Another sagittal reformatted image in arterial phase shows an irregular hypodense non-enhancing filling defect in the lumen of the thoracic aorta consistent with thrombus.
Mesenteric ischemia can be secondary to arterial or venous occlusion. An arterial origin is more common, with thrombosis or embolism of the major vessels supplying the gut.
Ischemia is of three grades:
- Grade I: reversible ischemic enteritis / colitis involving only mucosa and superficial submucosa
- Grade II: involvement of deeper submucosa and muscularis
- Grade III: transmural bowel wall necrosis / bowel infarction