Clinical History.—This 4-week-old girl was admitted to the Bernalillo County Medical Center following three days of progressive diarrhea and abdominal distention. She was moribund, hypothermic, and profoundly dehydrated. Because of the possibility of mechanical bowel obstruction, radiological studies of the abdomen were obtained (Fig 1 and 2). Laparotomy was performed, but the child died 24 hours after admission.
Denouement and Discussion
Enterocolitis With Bowel Necrosis and Gas in the Portal Venous System
The radiological demonstration of gas in the portal venous system generally is indicative of bowel necrosis and impending death. This phenomenon has been seen in adults and children with intestinal obstruction, mesenteric vascular occlusion, and necrotizing enterocolitis, this latter entity being encountered with greatest frequency in premature infants.1,2 Two theories exist as to the mechanism wherein gas enters the mesenteric and portal veins: (1) intraluminal gas, under pressure, penetrates the compromised bowel wall and gains access
Gwinn JL, Lee FA, Smalley RH, Wolfel DA. Radiological Case of the Month. Am J Dis Child. 1970;119(1):57-58. doi:10.1001/archpedi.1970.02100050059012