Portomesenteric venous gas.

CLINICAL PRESENTATION A 51-year-old man presented to our emergency department with severe sharp abdominal pain and coffee ground vomiting. He had a history of type 2 diabetes mellitus and end-stage renal disease with regular hemodialysis. Tachycardia (115 beats per minute) and respiratory distress (25 breaths per minute) were detected. Physical examination showed diffused abdominal tenderness and distention. Hemogram showed leukocytosis with left shift. Plain film of the abdomen showed intestinal pneumatosis (Figure 1A, arrows). Bedside abdominal ultrasonography showed diffuse linear areas of increasing echogenicity in the liver parenchyma, moving hyperechoic foci in the main portal vein, and gas accumulated in the splenic vein. Computed tomography showed mesenteric venous gas (Figure 1B, black arrows), intestinal pneumatosis (Figure 1B, arrowheads), and air portals (Figure 1B, white arrows) and confirmed the diagnosis of ischemic bowel. After involved bowel resection, the patient was discharged 30 days later uneventfully. Reported causes of portomesenteric venous gas include mucosal necrosis, bowel distention, sepsis, and idiopathic. Portomesenteric venous gas and pneumatosis intestinalis indicate acute bowel infraction.1 Computed tomography is a useful and preferred technique for showing the underlying etiology of ischemic bowel. Sonography may also be valuable because it is noninvasive, real time, readily availability, and more sensitive to gas.2