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An unusual cause of abdominal pain in a patient with hepatitis C cirrhosis
  1. A Cárdenas1,
  2. N H Afdhal1,
  3. K Khwaja2
  1. 1Liver Center, Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
  2. 2Department of Hepatobiliary Surgery and Liver Transplantation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
  1. Correspondence to:
    Dr A Cardenas
    Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St Ste 8E, Boston, MA 02215, USA; acardenabidmc.harvard.edu

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A 51 year man with a history of hepatitis C cirrhosis presented with a two day history of fever, malaise, abdominal distension, and severe abdominal pain in his right upper quadrant. On examination he had significant tenderness and guarding in his right upper quadrant. A computed tomography scan revealed a nodular and cirrhotic liver, moderate ascites, and enlarged spleen (fig 1A). There was air within the superior mesenteric veins (arrows) along with marked bowel wall thickening at the hepatic flexure and pneumatosis (arrowheads) suggesting necrotic bowel (fig 1A). He was taken to the operating room for an exploratory laparotomy that revealed a severely inflamed, enlarged, and indurated right hemicolon, without perforation. Right hemicolectomy with an end to end ileocolic anastomosis was successfully performed. The histology of the resected specimen is displayed in fig 1B.

Figure 1

 Computed tomography scan of the liver revealing a nodular and cirrhotic liver, moderate ascites, and enlarged spleen (A). There was air within the superior mesenteric veins (arrows) along with marked bowel wall thickening at the hepatic flexure and pneumatosis (arrowheads). (B, C) Histology of resected specimens.

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