A 58-year-old man came to the emergency department complaining of abdominal colic pain, nausea, vomiting and diarrhea for two days.
Your child had similar symptoms and both had taken quails cooked two days before.
The patient had been previously diagnosed with benign prostatic hypertrophy and arterial hypertension on treatment with angiotensin-II receptor antagonists and torasemide, as well as an episode of abdominal pain secondary to ibuprofen 6 months before taking ibuprofen.
Upon admission, the patient was afflicted and the physical examination showed no alterations in the abdominal area, cardiac or respiratory auscultation.
Complementary tests showed a complete blood count, renal function, amylase, lipase and liver function tests within normal ranges, with the exception of a serum bilirubin value of 1.80 mg/dl (higher urinary incontinence of 1.60 mg/dl).
Abdominal ultrasound showed small mobile hyperechoic foci within the main branch of the portal vein, along with multiple hypoechogenic zones distributed in both liver lobes suggestive of gas.
The gallbladder, pancreas head and small bowel loops visualized showed no alterations and there was no free fluid.
The only possible cause of pneumatosis could be the presence of thickening of the stomach wall, possibly related to emphysematous gastroduodenitis.
A computed tomography (CT) scan of the pelvis confirmed the presence of gas in the trunk and distal branches of the portal vein as well as in both liver lobes.
Ischemia, pelvic inflammation of the gallbladder and pelvic alterations were ruled out.
Contrary to previous ultrasound, the walls of the stomach appeared normal, although there was minimal gas in the short vessels of the stomach.
Although the case presentation resembled gastroenteritis secondary to food contamination, portal pneumatosis motivated the patient's admission.
He was treated with amoxicillin-clavulanate and decoagulated with subcutaneous low molecular weight heparin due to the risk of portal thrombosis secondary to pileflebitis.
Coprocultives were negative and the presence of Entamoeba histolytica, eggs and allergies was ruled out.
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After 4 days of treatment, the CT scan was repeated to confirm the diagnosis of portal pneumatosis.
The patient was discharged and seen at 6 months in outpatient clinics, being asymptomatic and with an abdominal ultrasound within normal limits.
