Classic pneumatosis intestinalis and hepatic portal venous gas in setting of severe abdominal aorta atherosclerosis

An 86-year-old man with extensive past medical history was referred to Emergency Department for evaluation of dehydration, hyperkalemia and worsening of mental status. In physical examination, abdomen was distended and tender with no bowel sounds. Abdominal computed tomographic imaging revealed pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) in presence of severe atherosclerotic calcification of abdominal aorta.