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Special Feature
August 18, 2008

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations:Department of Surgery, State University of New York Downstate Medical Center, Brooklyn, New York. Dr Kaufman is now with the Department of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein School of Medicine, Bronx, New York.




Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Surg. 2008;143(8):803. doi:10.1001/archsurg.143.8.803

A 77-year-old woman with hypertension, diabetes mellitus, end-stage renal disease, and hypothyroidism presented with nausea, vomiting, constipation, and obstipation of 1 day's duration. Her surgical history was significant for appendectomy, open cholecystectomy, and cesarean delivery. Physical examination revealed a moderately distended, soft, and mildly tender abdomen, and laboratory values showed mild leukocytosis. Computed tomography (CT) revealed distended loops of small bowel and gas in the mesenteric (Figure 1) and intrahepatic portal (Figure 2) veins.

Figure 1.
Image not available

Abdominal computed tomography showing streaks of air in the bowel mesentery.

Figure 2.
Image not available

Abdominal computed tomography showing arborizing streaks of air in the liver.

What Is the Diagnosis?

A. Benign portal venous gas

B. Acute mesenteric ischemia

C. Schistosomiasis

D. Portal pyelophlebitis