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.
Abdominal computed tomography showing streaks of air in the bowel mesentery.
Abdominal computed tomography showing arborizing streaks of air in the liver.
A. Benign portal venous gas
B. Acute mesenteric ischemia
D. Portal pyelophlebitis
Kaufman D, Kang KH, Schwartzman A. Image of the Month—Quiz Case. Arch Surg. 2008;143(8):803. doi:10.1001/archsurg.143.8.803