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case_images: Computed tomography without contrast undertaken on admission of a 77-year-old man with nonocclusive mesenteric ischemia. A, A small amount of hepatic portal venous gas in the left lobe (white arrows). B, Computed tomography did not reveal remarkable acute mesenteric ischemia findings, such as bowel wall thickening, a hyperattenuating bowel wall, and paper-thin bowel wall (white arrows).
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case_images: Computed tomography without contrast was carried out due to renal insufficiency; it revealed a small amount of HPVG in the left lobe (Fig. 1A).
case_images: Computed tomography of a 77-year-old man with nonocclusive mesenteric ischemia, carried out at 5 h postadmission with contrast enhancement. A, Spreading of hepatic portal venous gas in the left lobe (white arrows) compared with the initial scan. B, Remarkable bowel dilatation and pneumatosis intestinalis (white arrows) in the absence of contrast-induced bowel wall enhancement.
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case_images: No remarkable acute mesenteric ischemia finding, such as bowel dilatation or pneumatosis intestinalis, was observed (Fig. 2B). The HPVG had spread within the left lobe compared with the initial CT scan (Fig. 2A). The CT also revealed remarkable bowel dilatation and pneumatosis intestinalis in the absence of contrast-induced bowel wall enhancement (Fig. 2B).
case_images: Emergency laparotomy carried out in a 77-year-old man with nonocclusive mesenteric ischemia. The small bowel appears necrotic, with segmental and skip lesions visible at the initial operation.
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case_images: At the initial operation, necrosis was observed within the small bowel, with segmental and skip lesions (Fig. 3).