# Abdominal Ultrasound Detection of Portal Vein Gas in Non-occlusive Mesenteric Ischemia: A Case Report

## TL;DR

This case report shows that abdominal ultrasound can detect portal vein gas more effectively than CT in non-occlusive mesenteric ischemia, aiding early diagnosis and treatment.

## Contribution

The case highlights the potential of ultrasound as a more sensitive tool for detecting portal vein gas in non-occlusive mesenteric ischemia.

## Key findings

- Abdominal ultrasound detected more portal vein gas than CT in a patient with non-occlusive mesenteric ischemia.
- Postoperative ultrasound showed complete resolution of portal vein gas within 24 hours.
- The patient recovered well after surgical resection of the affected bowel segment.

## Abstract

Portal vein gas (PVG) is often associated with severe gastrointestinal disease and has traditionally been considered a marker of poor prognosis. While computed tomography (CT) is the most common modality for PVG detection, reports of detection via abdominal ultrasound (US) are limited. A 91-year-old bedridden woman presented with diarrhea and hematochezia. Abdominal US revealed multiple hyperechoic foci within the liver consistent with PVG, whereas CT demonstrated only a few PVG spots and non-enhancing small bowel segments. In the absence of superior mesenteric artery occlusion, she was diagnosed with non-occlusive mesenteric ischemia (NOMI). Emergency laparotomy revealed a 15-20 cm necrotic ileal segment, which was resected with formation of a double-barrel ileostomy. Histopathology confirmed NOMI. Postoperative recovery was uneventful, and she was discharged on day 19. Follow-up US within 24 hours of surgery showed complete resolution of PVG. This case demonstrates that the US may detect PVG more sensitively than CT in certain situations. Early US evaluation could facilitate timely diagnosis and intervention in severe abdominal conditions and may provide prognostic information based on the sonographic PVG pattern.