DOI: https://doi.org/10.36347/sjmcr.2025.v13i09.002

Pages: 1961-1964

Hepatic portal venous gas (HPVG) and intestinal pneumatosis are rare radiologic findings strongly associated with acute mesenteric ischemia and high mortality. Non-occlusive mesenteric ischemia (NOMI) results from mesenteric hypoperfusion and/or vasoconstriction and is often underrecognized in critically ill patients. Early diagnosis and timely intervention are crucial for favorable outcomes. We report a 71-year-old male with chronic kidney disease and prior rectal adenocarcinoma who presented with acute myocardial infarction complicated by cardiac arrest during coronary angioplasty. On Intensive Care Unit (ICU) day two, he developed epigastric pain; CT revealed extensive HPVG and intestinal pneumatosis. Exploratory laparotomy and staged laparostomy confirmed jejunal, gastric, and duodenal ischemia without gangrene. Gradual recovery allowed intestinal recovery and abdominal wall closure. Follow-up imaging showed complete resolution, and he was discharged 12 days after admission with full functional recovery. Concurrent HPVG and intestinal pneumatosis typically indicate advanced mesenteric ischemia and carry a poor prognosis. Nevertheless, this case demonstrates that early recognition, prompt imaging, staged surgical management, and multidisciplinary supportive care can result in favorable outcomes, even in critically ill patients with multiple comorbidities. Awareness of NOMI in high-risk patients is essential to guide timely intervention and improve survival.