advertisement1 advertisement  jfponline only  pubmed remember me register now! cheap viagra india  contemporary surgery case quizwhen mesenteric ischemia causes hpvg angelina  postoev,  md; matthew  l.   hazen,  md; hisham  elhassan,  md; john  d.   brownlee,  md department of surgery, huron hospital cleveland, oh ct scan confirmed this patient’s classic symptoms, but laparotomy was negative. 613 a 65-year-old man presented to the emergency department complaining of an acute onset of severe epigastric pain with nausea and vomiting. The patient’s medical history was complex: coronary artery disease, end-stage renal disease, hypertension, asthma, chronic obstructive pulmonary disease, central hypoventilation syndrome, hypothyroidism, subdural hematoma (sdh), and small cell lung cancer. His surgical history included arteriovenous fistula placement, sdh evacuation with craniotomy, cholecystectomy, ventral hernia repair, and coronary artery bypass grafting with aortic valve replacement. Take the case quiz figure 1 visible hpvg abdominal ct scan demonstrated air within the hepatic portal vein (arrow). Results of diagnostic testing because of the patient’s severe abdominal pain, nausea, and vomiting, we obtained abdominal and pelvic ct scans that showed extensive hepatic-portal venous gas (hpvg) ( figure 1 ). Ct scans showed that both the pancreatic and common bile ducts were dilated to 6 mm and 9 mm, respectively. Pneumatosis intestinalis was questionable. The ct scan also demonstrated severe arteriosclerosis throughout the abdominal aorta ( figure 2 ). 614 figure 2 severe arteriosclerosis ct scan showed evidence of severe arteriosclerosis in the abdominal aorta (arrow). Initial laboratory values indicated anemia, although white blood cell and platelet counts were normal ( table ). An electrocardiogram showed a sinus rhythm with premature atrial complexes and prolonged qt intervals. Fast track ct scans showed extensive hpvg and dilated pancreatic and co.