Unusual radiological finding of lethal pneumatosis intestinalis and portomesenteric vein gas

Abstract

Pneumatosis intestinalis and portomesenteric vein gas are rare and potentially severe radiological findings that occur both in pediatric and adult populations. They actually are radiographic signs of underlying intra-abdominal pathology, abnormality or diagnostic medical interference. If combined with other radiological or clinical signs of intestinal ischemia or sepsis, the prognosis is dismal and urgent laparotomy is mandatory. We report two cases of surgical treatment with ominous outcome in an effort to characterize this finding correctly as an absolute surgical indication or as an additional diagnostic criterion that simply marks a further breakdown of the systems in patients with a long list of severe medical conditions.

Radiography and ultrasonography of pneumatosis intestinalis in a cat

“…Portal venous gas has been frequently reported as a concurrent finding when bowel wall ischemia and necrosis are present in human reports and has been suggested in the veterinary literature . Portal venous gas has also been associated with hydrogen peroxide ingestion in a dog .…”

“…While the long‐term prognosis is unknown in veterinary patients and likely depends on the underlying etiology, this case suggests that detailed investigations aimed at identifying its etiology should be performed. In human medicine, computed tomography has increased sensitivity for identifying pneumatosis intestinalis and portal venous gas, therefore this may be a future consideration for increasing sensitivity in our veterinary patients …”