This case nicely demonstrates the typical sequelae of severe bowel wall ischemia and necrosis with subsequent loss of integrity and barrier function of the bowel wall, as evidenced by the pneumatosis intestinalis and extensive portomesenteric venous gas. This patient suffered from longstanding atrial fibrillation, the likely main contributor to the thromboembolic occlusion of the SMA.

The peripheral distribution of intrahepatic gas makes it easy to distinguish from aerobilia, which is usually located centrally.