1. SYB 3 General Radiology An Dang Do March 5, 2008

2. 79 yo WM POD #8, cystectomy; acute onset of severe abdominal pain; (recently received chemotherapy treatments for urothelial cancer)

3. CT Image

8. Necrotizing Enterocolitis -one of the more concerning causes of portal venous gas -most common in immunosuppressed patients -necrosis of various layers of bowel walls, almost always cecum (typhlitis) Contributing factors: mucosal injury profound neutropenia impaired host defense Microbes involved: Gram(-) rods; Gram (+) cocci; anaerobes; Candida sp. Signs and symptoms: ANC < 500/microL fever, abdominal pain/distension, N/V, watery/bloody diarrhea Song L-M WK, Marcon NE. Necrotizing enterocolitis (typhlitis) in adults. UpToDate. Version 15.3. Accessed March 4, 2008.

9. Necrotizing Enterocolitis - Management

10. Iatrogenic Complication CXR taken after placement of left subclavian line

11. Lines and Tubes

12. Portal venous gas Free air in abdomen Distended stomach CT Image Although findings of portal venous gas, thickened proximal jejunal wall, pneumatosis and pneumoperitoneal were seen on CT and prompted concerns for necrotizing enterocolitis, two exploratory laparotomy procedures did not show any ischemic bowels or perforation.

13. Iatrogenic Complication Left pneumothorax

14. Lines and Tubes Mediport NG tube ET tube Keofeed tube Chest tube Swan-Ganz catheter