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Updated: Aug 13, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Evolution of two unusual radiological findings in a patient with mesenteric ischemia
Cristina María Gras Gómez1, José Ruiz Pardo2, Javier Martín Cano2
1Cirugía General y del Aparato Digestivo, Hospital Universitario Torrecárdenas, España.
Abstract:
Portal pneumatosis has been considered an ominous sign associated with intestinal ischemia, with a mortality rate of up to 90% as long as it is associated with sepsis. However, the prognosis of mesenteric ischemia depends on the etiology rather than the presence of portal pneumatosis. We present a patient with portal pneumatosis that disappeared 24 hours after the first surgery, but irreversible ischemic lesions were established in the terminal ileum. It should be noted that the excretion of the intravenous contrast is mainly through the kidneys, and it can be eliminated through alternative routes such as the bile duct or the mucosa of the small intestine (vicariant excretion), especially in patients with renal pathology.
Insights
Portal pneumatosis, often linked to high mortality in intestinal ischemia, may not solely determine patient outcomes. The underlying cause of mesenteric ischemia is a more critical prognostic factor.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Radiology
Background:
- Portal pneumatosis is traditionally viewed as a severe indicator of intestinal ischemia, often associated with high mortality rates, particularly when sepsis is present.
- The established view suggests a grave prognosis for patients with portal pneumatosis and intestinal ischemia.
Observation:
- A case study involving a patient with portal pneumatosis is presented.
- The portal pneumatosis resolved within 24 hours following initial surgical intervention.
- Despite the resolution of portal pneumatosis, irreversible ischemic damage was confirmed in the terminal ileum.
Findings:
- The prognosis of mesenteric ischemia is primarily dictated by its etiology, not solely by the presence of portal pneumatosis.
- Vicariant excretion of intravenous contrast agents can occur via the biliary system or small intestinal mucosa, especially in cases of renal compromise.
Implications:
- Rethinking the prognostic significance of portal pneumatosis in mesenteric ischemia is warranted.
- Clinical management and prognosis should focus on the underlying cause of ischemia and potential contrast excretion pathways.
- Further research into the diagnostic and prognostic value of portal pneumatosis in diverse clinical scenarios is needed.
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