A -year-old woman is brought to the emergency department from a skilled nursing facility due to severe, diffuse abdominal pain that began abruptly hours ago. She has a medical history of paroxysmal atrial fibrillation, heart failure with preserved ejection fraction, and hypertension. Current medications include metoprolol and lisinopril; she stopped taking apixaban three weeks ago due to financial constraints. On examination, the patient is distressed and diaphoretic. Temperature is (), blood pressure is mmHg, pulse is /min and irregularly irregular, and respirations are /min. Abdominal examination reveals mild, diffuse tenderness to deep palpation without rebound or guarding, which appears disproportionately mild compared to her reported pain severity. Laboratory studies show a leukocyte count of and a serum lactate level of mmol/L. A contrast-enhanced CT scan of the abdomen and pelvis is performed. The radiologist notes segmental mural hypoenhancement and wall thinning involving the distal jejunum and proximal ileum. Additionally, there are distinct, linear, branching areas of low attenuation (gas density) extending predominantly into the peripheral subcapsular regions of the liver. Which of the following is the most accurate interpretation of the hepatic imaging findings in the context of this patient's presentation?
- Accumulation of gas within the portal venous system due to transmural bowel infarctionCevap
- BRetrograde flow of air into the central biliary tree due to incompetence of the sphincter of Oddi
- CGas-forming bacterial infection of the gallbladder wall with contiguous hepatic extension
- DHematogenous seeding of anaerobic bacteria resulting in early hepatic microabscess formation
- EFree intraperitoneal air collecting in the perihepatic space due to a perforated viscus