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Nephrology Dialysis Transplantation 2004 19(10):2672; doi:10.1093/ndt/gfh267
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Nephrol Dial Transplant Vol. 19 No. 10 © ERA-EDTA 2004; all rights reserved

Images in Nephrology
(Section Editor: G. H. Neild)

Air in the liver?

Asher Korzets1,4, David Sachs1,4, Regina Gershkovich1,4, Uri Soimu2,4, Gabriel Bartal2,4, Boris Kessel3,4, Sonia Dudaiav1,4 and Abraham Chlibovsky1,4

1 Department of Nephrology, 2 Department of Radiology and 3 Department of Surgery B, Hillel-Yaffe Hospital, Hadera, Israel and 4 Rappaport Faculty of Medicine, the Technion, Haifa, Israel

Correspondence and offprint requests to: Asher Korzets, Nephrology Department, Rabin Medical Center (Hasharon), Petach Tikva, Israel. Email: aradmt{at}012.net.il

Keywords: haemodialysis; mesenteric ischaemia; pneumatosis intestinalis; portomesenteric air

Case

A 52-year-old male chronic haemodialysis (HD) patient was admitted with a 12 h history of severe, diffuse abdominal pain. Pain had commenced during the final hour of the patient's previous HD session. The patient had been on dialysis for 22 years. Calciphylaxis of skin over the calf had been successfully treated with daily HD over a 3 month period.

On examination the patient was in distress, hypotensive and exhibited abdominal swelling and guarding. Serum LDH levels were markedly elevated. A CT of the abdomen showed three signs of advanced mesenteric ischaemia with possible bowel necrosis: pneumatosis intestinalis (Figure 1), air in the mesenteric vessels (Figure 1) and air in the portal venous system (Figure 2) (1,2).



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  		Fig. 1. Pneumatosis intestinalis (block arrow) and air in the mesenteric vessels (broad arrowhead).

 


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  		Fig. 2. Air in the portal venous system.

 
Despite three laparotomies and the removal of necrotic distal small bowel, the patient died. Light microscopy examination revealed extensive medial calcification of medium and small size mesenteric arteries. The final diagnosis was non-occlusive mesenteric ischaemia and subsequent bowel necrosis.

Conflict of interest statement. None declared.

References

  1. Brandt LJ, Boley SJ. AGA technical review on intestinal ischemia. Gastroenterology 2000; 118: 954–968.[CrossRef][Web of Science][Medline]
  2. Weisner W, Mortele KJ, Glickman JN, Ji H, Ros PR. Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. Am J Roentgenol 2001; 177: 1319–1323.[Abstract/Free Full Text]

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