Gas in the portomesenteric vessels from nonocclusive ischemic bowel disease.

摘要

A woman with known Crohn's disease and a previous partial resection of her small intestine presented with a poor appetite, weight loss, diarrhea and malnutrition. She was an ex-smoker and was taking antihypertensive therapy. Results of an upper gastrointestinal series showed stenotic areas in the ileum. The patient was admitted to hospital with a presumed exacerbation of inflammatory bowel disease. However, acute abdominal pain and distension developed despite treatment, and she became hypotensive and nonrespon-sive. Resuscitation efforts were initiated, and a nasogastric tube was inserted which drained bloody fluid. A plain abdominal radiograph (Fig. 1) showed air in the portomesenteric vascular system. Gastroscopy was per- formed and showed extensive mucosal ulcerations. An emergency laparotomy revealed zones of necrosis throughout the small intestine and bowel; however, no curative treatment could be done, and the woman died shortly after withdrawal of life support Autopsy revealed extensive nontransmural gastric ulcers, necrotic areas in the small and large intestines, and nonocclusive atheroma-tous plaques in the aorta and at the origin of the inferior mesenteric artery. The final diagnosis was ischemic en-terocolitis due to nonocclusive arterial stenosis and diffuse atheromatosis.