Portal Vein Gas From lesenteric Ischemia

摘要

A 78-year-old man with diabetes, hypertension, and end-stage renal disease presented to the emergency department (ED) with diffuse abdominal pain that started while he was receiving hemodialysis. He described the pain as crampy and more severe in the lower abdomen. He also felt nauseated and vomited non-bilious, non-bloody stomach contents several times. Because of the pain, he was able to complete only 2 hours of dialysis.On arrival at die ED, the patient was awake but confused and his abdomen was firm, distended, and tympanitic, with rebound and guarding. No bowel sounds were audible. Vital signs and the rest of the physical examination findings were normal.The patient's lactate level was 6 mmol/L. White blood cell count was 15,500/muL. A CT scan of the abdomen and pelvis showed diffuse bowel wall thickening, pneumatosis in-testinalis (A), pneumobilia, and pneumatosis.of the portal system (B and C).