Images: Portal Venous Gas and Pneumatosis Intestinalis
Diana L. Diesen, MD ∙ Dan G. Blazer III, MD
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Citation: Diesen DL, Blazer DG. Images: Portal venous gas and pneumatosis intestinalis. J Surg Radiol. 2011 Jan 1;2(1).
Received: October 1, 2010; Accepted: November 17, 2010; Published: November 23, 2010 Copyright: © 2010 Surgisphere Corporation. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
An 82-year-old man with an EUS T3 N1 obstructing distal gastric cancer who was undergoing neoadjuvant chemoradiation therapy presented at a routine clinic visit complaining of dehydration, fatigue, and crampy lower abdominal pain. He reported one day of progressive malaise and abdominal pain. In clinic, he became short of breath and orthostatic. The patient was taken to the emergency room where he was noted to be more somnolent and hypotensive with diffuse abdominal pain and tenderness. IV fluids, antibiotics, and pressors were initiated. Abdominal x-ray revealed gas in the portal venous system and air-fluid levels in the small bowel. An abdominal pelvic CT was performed which showed diffuse portal venous gas and pneumatosis intestinalis involving the majority of the small and large bowel with nonenhancement of the bowel wall concerning for ischemia. Considering the extensive pneumatosis and portal venous gas on the CT scan, the patient’s advanced cancer diagnosis, and his poor performance status, the patient's family felt that comfort measures would best. The patient expired within a few hours.
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