The CT abdomen was abnormal with aerobilia, portal venous gas and extensive pneumatosis of a large part of the jejunum. Inflammation of the pancreatic parenchyma and peripancreatic tissues with partial pancreatic parenchymal necrosis was found. There was normal perfusion of the aorta and large abdominal arteries.
In conclusion, this patient suffered from a severe necrotising pancreatitis (APACHE II score 16; CT severity index 10). Due to the extensiveness of the necrosis, surgery was not possible. The patient was treated with broad-spectrum antibiotics and vasopressors on the intensive care unit. Despite this treatment her condition deteriorated quickly and eventually the patient refused any further treatment.
Hepatic portal venous gas in combination with the presence of pneumatosis intestinalis is a severe condition with high mortality rates. It is mostly associated with full-thickness bowel wall necrosis, but also described in other conditions such as necrotising pancreatitis.