Acute Mesenteric Ischemia with Intrasplenic Gas: A Rare Occurence

Abstract

CaseA 55-year-old male patient came to emergency department of our hospital with history of acute onset severe diffuse abdominal pain for one day. there was no history of diabetes or hypertension. However, he gave vague past history of chest pain for which he did not avail any treatment. On admission, patient had tachycardia with pulse rate of 120 beats per minute and blood pressure was 90/60 mmHg. Electrocardiogram showed features of ischemic heart disease. Clinical examination revealed distended abdomen with absent bowel sounds. there were no signs of peritonitis. Clinically a diagnosis of mesenteric ischemia was suspected. Immediately, he was resuscitated with intravenous fluids and ryle's tube was inserted. His blood urea, sugar, serum creatinine and electrolyte levels were within normal limits. the total white cell count was elevated with 18,000 cells per cu.mm and neutrophilia. He was rushed to radiology department for computed tomography (Ct) angiography with contrast Ct of the abdomen. topogram of Ct abdomen itself showed presence of pneumatosis intestinalis in lower abdomen with doubtful presence of portal venous gas [table/ Fig-1]. Ct angiography and contrast Ct abdomen showed occlusion of both celiac axis and superior mesenteric artery from its origin [table/ Fig-2] with presence of portal venous gas in both lobes of liver [table/ Fig-3a]. Multiple hepatic and splenic infarcts were also noted [table/ Fig-3b]. Splenic