Fig. 14

Progression of venous ischemia from early to late stage in a 58 y/o male presenting with abdominal pain. On day 1 (a, b), baseline Imaging demonstrates extensive SMV thrombosis (arrowhead) with associated small bowel wall (curved arrow) and mesenteric edema (thick arrow), compatible with early stage of ischemia. On day 3 (c), follow-up scan demonstrates bowel wall thinning with extraluminal oral contrast (thin arrows) as mesenteric venous contrast intravasation, suggestive of Intermediate stage ischemia. On day 7 (d), subsequent CT shows extensive pneumatosis (asterisks) and pneumoperitoneum (dotted arrow), in keeping with late-stage ischemia. Please notice that oral contrast intravasation can precede transmural bowel necrosis