Portal venous gas due to ischemia

Case contributed by Stefan Tigges
Diagnosis certain


Abdominal pain

Patient Data

Age: 75 years
Gender: Female

Lungs clear, heart normal in size. Subtle branching lucency involving the liver.

Liver is normal in size. Large amount of portal venous gas. Nonenhancement of the wall of the multiple distal small bowel loops, the right colon and the proximal transverse colon with pneumatosis intestinalis and extensive gas within mesenteric portal venous tributaries, consistent with ischemia. Ischemic loops of small bowel are dilated without transition point. Severe stenosis proximal celiac axis and complete occlusion of the superior mesenteric artery origin.

Confirms severe stenosis celiac axis and SMA occlusion. The inferior mesenteric artery is patent.

Case Discussion

Excellent example of portal venous gas due to ischemic bowel. It is important to be able to distinguish pneumobilia from portal venous gas. This is usually done by determining whether the gas is primarily peripheral or central. Since bile flows from peripheral to central, biliary gas is centrally located. Conversely, the central to peripheral flow of portal venous blood through the liver means that portal gas ends up peripherally located. In this case, there is obvious gas within the superior mesenteric vein.

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