CASE 51: Pneumatosis Intestinalis and Portal Vein Gas in Two Kidney-Pancreas Recipients

Male in his 60s with a complex medical history inclusive of atrial fibrillation, lymphoma, pacemaker placement, and a distant history of a simultaneous kidney pancreas transplant (both organs currently non-functional) complicated by an intestinal anastomotic leak, who presented with abdominal pain after a fall. CT images obtained in the emergency room as part of an initial workup show gas in the portal venous system (pink arrows).

CT image showing intestinal pneumatosis (yellow arrows) in the region of the dilated transplant duodenum (red arrow) and its anastomosis to the recipient small bowel. Note the staple line (green arrow) in the duodenum (red arrow) of the transplanted pancreas (light orange arrow). Note also the transplanted kidney (blue arrow).

CT image showing pneumatosis (yellow arrows) in a dilated intestinal loop in the region of the transplant duodenum and its anastomosis to the recipient small bowel. The transplant kidney is shown with a blue arrow.

Poorly enhancing dilated loops of small and large bowel with extensive intestinal pneumatosis (yellow arrows) and portal venous gas (pink arrows). Note the marked dilatation in the region of the transplant duodenum (red arrow) and its anastomosis to the recipient small bowel (purple arrow). Although there is extensive pneumatosis, no free air was identified. Note also the transplanted kidney (blue arrow).

Poorly enhancing dilated loops of small and large bowel with extensive intestinal pneumatosis (yellow arrows) and portal venous gas (pink arrows). Note the marked dilatation in the region of the transplant duodenum (red arrow) and its anastomosis to the recipient small bowel (purple arrow). Although there is extensive pneumatosis, no free air was identified. Note also the transplanted kidney (blue arrow).

Poorly enhancing dilated loops of small and large bowel with extensive intestinal pneumatosis (yellow arrows) and portal venous gas (pink arrows). Note the marked dilatation in the region of the transplant duodenum (red arrow) and its anastomosis to the recipient small bowel (purple arrow). Although there is extensive pneumatosis, no free air was identified. Note also the transplanted kidney (blue arrow).

Dilated intestinal loops with areas of ischemia were identified on exploratory laparotomy. There was no transmural necrosis or perforation. The anastomosis (white arrows) between transplant duodenum (black arrows) and recipient small bowel (blue arrows) was intact. The abdomen was closed without performing any type of resection.

Dilated intestinal loops with areas of ...