Inpatient with abdominal pain

An inpatient on the surgical service complains of abdominal pain. Recent inferior mesenteric artery territory embolization after acute lower GI bleed.

Description: Show

Multiple loops of small bowel are mildly dilated, and bubbles of gas can be seen in the non-dependent (posterior, since patient is supine) portion of the bowel, suggesting gas in the bowel wall, known as pneumatosis.

A few of these loops of small bowel also show hypoenhancement of the bowel wall, especially when compared to adjacent loops, suggestive of ischemia or poor perfusion.

Gas is also seen in the portal venous system, most obviously in the liver. This is due to gas from the bowel wall leaking into draining mesenteric veins, which drain through the portal system to the liver. A few slices show gas directly within the mesenteric veins.

Diagnosis: Show

Bowel ischemia/infarct, which could be related to an episode of hypotension related to the acute GI bleed, or else related to the arterial embolization procedure itself.

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