Case Presentation

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Case Presentation
Submitted by
Huy Le, MS4
Faculty reviewer
Sandra Oldham, M.D
Date accepted
30 August 2007
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Case History

• 73 year old obese Hispanic male presents to the
  ER with a 5 day history of abdominal pain
  associated with nausea and vomiting. 6 hours
  before going to the ER, the patient started
  having hematemesis, and bright red blood per
  rectum (hematochezia). The pain is constant,
  8/10, and does not change with eating. The
  patient has been unable to keep anything down due
  to nausea.
• PMH DM type II, HTN, Chronic renal failure
  secondary to DM on chronic renal dialysis

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Radiological Presentations
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Radiological Presentations

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Radiological Presentations

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Radiological Presentations

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Radiological Presentations

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Radiological Presentations

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Radiological Presentations

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Radiological Presentations

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Radiological Presentations

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Radiological Presentations

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Radiological Presentations

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Air in hepatic portal system, dilated loops of
bowel, air fluid level in bowel, air in bowel
walls (pneumatosis intestinalis), air in
mesentery.
Findings and Differentials
Findings
Differentials

• bowel perforation
• mesenteric ischemia
• GI carcinoma
• hepatocellular carcinoma

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Discussion

• What are the causes of mesenteric ischemia?
• Superior Mesenteric artery embolism (30)
• Superior Mesenteric artery thrombosis (10)
• Non-occlusive mesenteric ischemia (50)
• Congestive heart failure
• Hypotension
• Hemorrhagic blood loss
• Sepsis
• Medications (Pressors, Digitalis)
• Mesenteric venous thrombosis (10)
• Secondary mesenteric ischemia (obstructive)

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Discussion

• What is the treatment?
• Acute mesenteric ischemia is treated by emergent
  surgery if there is bowel necrosis. If there are
  no signs of necrosis, other less invasive
  approaches may be considered.

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Mesenteric ischemia with subsequent bowel
necrosis.
Diagnosis
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1. Wiesner W, Mortelé KJ, Glickman JN, Ji H, Ros
PR. Portal venous gas unrelated to mesenteric
ischemia. Eur Radiol 2002 Jun12(6)1432-7.2.
Sebastià C, Quiroga S, Espin E, et al.
Portomesenteric vein gas pathologic mechanisms,
CT findings, and prognosis. RadioGraphics 2000
20 1213-1224.3. Paran H, Epstein T, Gutman M,
et al. Mesenteric and portal vein gas
computerized tomography findings and clinical
significance. Dig Surg 2003 20 127-132.4.
Chang RW, Chang JB, Longo WE. Update in
management of mesenteric ischemia. World J
Gastroenterol. May 28 2006 12(20)3243-7.5.
UptoDate
References