Reversal of Bowel Wall Pneumatosis After Superior Mesenteric Artery Stenting.

A 75 year old man presented with worsening abdominal pain for five days and raised CRP (305 mg/L). A high grade stenosis of the proximal superior mesenteric artery (SMA) was noted on computed tomography angiography (CTA; A) with diffuse bowel wall pneumatosis and mesenteric (arrowhead) and portal venous gas (arrow) consistent with acute mesenteric ischaemia. Emergency percutaneous covered SMA stenting was performed (BeGraft 27 × 8 mm, Bentley Innomed, Hechtingen, Germany), followed by laparoscopic exploration where no intestinal necrosis was found. Post-operative CTA (B) demonstrated stent patency and impressive complete reversal of pneumatosis and venous gas. No intestinal resection was needed.