PMC6336625_01
Abdominal upright radiograph 5 days after the operation. The stomach and intestine are markedly dilated with gas, and air-fluid levels are seen, indicating paralytic ileus.
medi-98-e14079-g001.jpg
PMC6336625_01_medi-98-e14079-g001.jpg
F1
An upright abdominal radiograph showed marked gaseous dilatation of the stomach, small intestine, and colon with air-fluid levels, indicating paralytic ileus (Fig. 1).
Postmortem computed tomography reveals extensive dilatation of intrahepatic portal veins in left and right branches and central and peripheral vessels and marked gastric and intestinal distention with fine, bubble-like aerocysts in the walls. These radiological findings indicate the presence of hepatic portal venous gas, pneumatosis intestinalis, and gastric pneumatosis.
medi-98-e14079-g002.jpg
PMC6336625_01_medi-98-e14079-g002.jpg
F2
Computed tomography revealed marked PI, gastric pneumatosis, and HPVG (Fig. 2), but it did not indicate any clear cause of these pneumatosis.
Autopsy findings in the intestine and stomach. (A) Markedly dilated and necrotic small intestine that spilled out as the abdomen was opened, suggesting an increased intestinal and intra-abdominal pressure. (B) Numerous bubble-like aerocysts are diffusely present in the intestinal mucosa. (C-F) Histologically, aerocysts are identified particularly in the lamina propria mucosae and submucosa of the small intestine (C-E) and stomach walls (F). Hematoxylin and eosin staining. Bar = 1.5 mm for C, and 200 mum for D, E, and F.
medi-98-e14079-g003.jpg
PMC6336625_01_medi-98-e14079-g003.jpg
F3
However, there was marked gastric and intestinal pneumatosis, especially from the jejunum to the ileum, with the intestines spilling out as soon as the abdomen was opened (Fig. 3A and B). Histologically, there were ischemic changes indicated by mucosal thinning and necrosis of the gastrointestinal wall, as well as marked pneumatosis in the mucosal lamina propria and submucosa (Fig. 3C-F).
Autopsy findings in the liver. (A, B) Central and peripheral (arrow) portal veins are markedly dilated. (C) Histologically, the portal veins in Glisson's sheaths are dilated, but the venous walls are structurally normal. Hematoxylin and eosin staining. Bar = 200 mum.
medi-98-e14079-g004.jpg
PMC6336625_01_medi-98-e14079-g004.jpg
F4
The intrahepatic portal veins were markedly dilated due to gas accumulation, but the portal vein walls themselves were structurally normal (Fig. 4).