PMC6129327_01
CT of abdomen revealed chronic bowel dilation and pneumatosis intestinalis ((a) and (b)); emergency of portal vein gas and worsening pneumatosis intestinalis (c); improvement after subtotal colectomy (d). Red arrow: pneumatosis intestinalis; blue arrow: portal vein gas.
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A subsequent computed tomography (CT) scan of the abdomen that showed significantly dilated colon and pneumatosis intestinalis (Figure 1). CT scan of abdomen/pelvis showed distended small and large bowel loops, portal venous gas, and pneumatosis within the jejunum and colon (Figure 1). Clinical diagnosis of bowel perforation was made, for which patient underwent emergent exploratory laparotomy.
Perforation site in the ascending colon. (a) Gross image of perforation site in ascending colon. (b,c) H&E staining revealed the extensive mucosal necrosis or ulceration and overlying fibrinopurulent exudate.
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Pathological findings were consistent with colonic perforation with transmural ischemic necrosis and fibrosis (Figure 2).
CT angiography abdomen revealed stenosis of mesenteric artery (a). Arteriogram indicated patent mesenteric artery (b). Arrow: mesenteric artery.
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CT angiography and conventional angiogram were performed to determine the culprit artery for bowel ischemia and identified a noncritical stenosis in superior mesenteric artery (Figure 3).