PMC6442441_01
Plain abdominal CT scan on admission showing dilatation of the stomach (arrowhead) and second portion of the duodenum (arrow) (a). Contrast-enhanced CT scan on hospital day 11 showing gas within the wall of a distended stomach (arrowheads) and portal vein (circled region). An arrow demonstrating the tip of the feeding tube (b). Follow-up CT scan showing improvement of gas in the stomach and portal vein (c). Sagittal view showing an acute angle of the aorto-superior mesenteric artery (arrow) and a collapsed duodenum (arrowhead) (d).
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While computed tomography (CT) examination of the head revealed no abnormalities, abdominal CT showed dilatation of the stomach and second portion of duodenum (Figure 1(a)). Persistent abdominal pain and detection of ascites by ultrasound led us to perform contrast-enhanced CT, which revealed intraluminal air in the distended gastric wall with hepatic portal venous gas (Figure 1(b)). Follow-up abdominal CT scan on day 19 showed improvement of the gas in the stomach and portal vein (Figure 1(c)). The aorta-superior mesenteric artery (SMA) angle and distance were 17 degrees and 4 mm, respectively (Figure 1(d)), suggesting SMAS as an underlying condition.
Esophagogastroduodenoscopy demonstrating diffuse mucosal edema, redness, and erosive lesions with white coating throughout the stomach (a), which was resolved (b).
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Esophagogastroduodenoscopy (EGD) demonstrated edema, redness, and erosion, with a white coating throughout the stomach without evidence of active bleeding or obvious necrotic lesions (Figure 2(a)). EGD on the same day (Figure 2(b)). Enteral nutrition was resumed uneventfully.