The patient had a recent history of subtotal colectomy for Crohn disease and presented with abdominal pain and thrombosis of SMV, PV, and splenic vein with small bowel ischemia.

Note the small bowel thickening with the targetoid appearance which can be seen with either venous ischemia (elevated venous pressures/preserved arterial inflow) or arterial ischemia after reperfusion (reperfusion injury). The patient was treated with anticoagulation and TIPS, but unfortunately developed worsening pain and had purulent ascites discovered after an abdominal drain was placed, and underwent a repeated CT showing pneumatosis and perforation of small bowel due to ischemia.