1 Department of Nephrology, 2 Department of Radiology and 3 Department of Surgery B, Hillel-Yaffe Hospital, Hadera, Israel and 4 Rappaport Faculty of Medicine, the Technion, Haifa, Israel
Correspondence and offprint requests to: Asher Korzets, Nephrology Department, Rabin Medical Center (Hasharon), Petach Tikva, Israel. Email: aradmt{at}012.net.il
Keywords: haemodialysis; mesenteric ischaemia; pneumatosis intestinalis; portomesenteric air
Case
A 52-year-old male chronic haemodialysis (HD) patient was admitted with a 12 h history of severe, diffuse abdominal pain. Pain had commenced during the final hour of the patient's previous HD session. The patient had been on dialysis for 22 years. Calciphylaxis of skin over the calf had been successfully treated with daily HD over a 3 month period.
On examination the patient was in distress, hypotensive and exhibited abdominal swelling and guarding. Serum LDH levels were markedly elevated. A CT of the abdomen showed three signs of advanced mesenteric ischaemia with possible bowel necrosis: pneumatosis intestinalis (Figure 1), air in the mesenteric vessels (Figure 1) and air in the portal venous system (Figure 2) (1,2).
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Conflict of interest statement. None declared.
References