IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Ischemic bowel

Case contributed by Bruno Di Muzio
Diagnosis certain

Presentation

Acute onset of abdominal pain and distension. History of previous surgery for pancreatic neoplasia.

Patient Data

Age: 75 years
Gender: Female

CT Abdomen and pelvis

ct

There is extensive small bowel dilatation with loops showing absent mural enhancement and mural gas (particularly in the jejunum).

The ascending colon appears thick-walled, up to the proximal transverse colon.

Gas is also seen in the branches of the superior mesenteric vein, and peripherally in the liver.

Cavernous transformation of the portal vein. 

A small amount of free peritoneal fluid is present. 

There is evidence of prior pancreatic surgery with a mass seen in the surgical bed, encasing and occluding the superior mesenteric artery. 

Annotated image

Extensive small bowel dilatation, absent mural enhancement with prominent mural gas seen best in the jejunum ( * ).

The ascending colon appears thick-walled (yellow arrows), up to the proximal transverse colon.

Gas is also seen in the branches of the superior mesenteric vein, and peripherally in the liver (green arrows).

There is evidence of prior pancreatic surgery with a mass seen in the surgical bed (red), encasing and occluding the superior mesenteric artery (SMA) and celiac trunk (CT) 

Cavernous transformation of the portal vein (orange). 

Case Discussion

Intramural gas (also known as pneumatosis intestinalis) refers to gas within the wall of the bowel and can be associated with ischemia and infarction, and usually carries a dismal prognosis. Even if this patient were to survive the acute illness, she would require most of the small bowel resected which leads to enormous morbidity (e.g. short bowel syndrome, requiring total parenteral nutrition etc...). 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.