Venous mesenteric ischemia

Discussion:

Many features of venous bowel ischemia seen in this case: dilated bowel loops with diffuse wall thickening, bowel wall gas, extensive gas seen inside the portomesenteric circulation and intrahepatic portal vein branches (pneumatosis portalis). Also, there is stranding of the mesenteric fat and mild free fluid, which are sequelae of venous blood flow compromise.

Post IV contrast study shows non-enhancement of bowel loops (i.e. bowel infarction) with no contrast enhancement of the mesenteric, portal and splenic veins. 

Extraintestinal CT findings of venous ischemia seen in this case include splenic and bilateral renal infarcts in terms of multiple linear non-enhancing areas.

Due to extensive infarction process and critical condition of the patient, left adrenal hemorrhage is also noted.

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