Renal, Pancreatic, Splenic, Mesenteric, and Portal Venous Gas as a Sign of Intestinal Necrosis

A, Supine abdominal radiograph demonstrates marked distension of the stomach and small bowel and pneumatosis intestinalis (white arrows). Air is seen in the branches of the portal veins (black arrows) in the B, liver (L), C, spleen (Sp), and along the course of the splenic vein (spl v) and the portal vein (pv).

A-C, Non-enhanced axial computed tomography scan with D, coronal reformats, showing marked gastric dilatation (St) and pneumatosis (white arrows) in the A, stomach wall and B, small intestinal wall (SB). A, B, D, Extensive portal venous gas (black arrows) is seen in the liver (L), B and D, and venous air (black arrows) within the spleen (Sp), the kidneys (K), and the pancreas (P), B, along the splenic vein (spl v) and the pancreatic veins, and C, in the renal veins (arrowheads).

Intraoperative photograph shows marked distension of the stomach (St) and necrotic small bowel loops (SB), with air bubbles (white arrows) on the small bowel outer wall.