• Prajwal Dahal, Sharma Paudel, Rakesh Kumar Sah, Sabina Parajuli, and Kiran Kayastha.
• Department of Radiology and Imaging, Grande International Hospital, Tokha, Kathmandu, Nepal.
• JNMA J Nepal Med Assoc. 2023 Oct 1; 61 (266): 834836834-836.

UnlabelledMesenteric ischemia is a surgical emergency. The presence of hepatic portal venous gas and pneumatosis intestinalis is a frequent finding in computed tomography. Not all hepatic portal venous gas and pneumatosis intestinalis are due to mesenteric ischemia. A 70-year-old female, with a known case of diabetes mellitus, rheumatic heart disease and atrial fibrillation under warfarin presented with diffuse abdominal pain, multiple episodes of vomiting and ecchymosis in bilateral flanks. Evaluation of the coagulation profile suggested warfarin-induced coagulopathy. Portal venous gas was detected during an ultrasound examination. Subsequent contrast-enhanced computed tomography abdomen showed hepatic portal venous gas, pneumatosis intestinalis, paucity of branches of the ileocolic artery, and reduced enhancement of caecum and ascending colon. Mild ascites were present in the pelvis. Arterial blood gas analysis revealed compensated metabolic acidosis. The patient was managed conservatively and discharged after nine days of hospital admission. Conservative approach can be considered for suspected mesenteric ischemia in surgically unfit candidates.Keywordscase reports; mesenteric ischemia; portal vein; rheumatic heart disease; warfarin.

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