Volume 122, Issue 2, Pages (February 2002)

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Volume 122, Issue 2, Pages 495-499 (February 2002) Intestinal ischemia and peripheral gangrene in a patient with chronic renal failure Jesús Rivera-Nieves, Giorgos Bamias, Jonathan Alfert, Stephen J. Bickston, Christopher A. Moskaluk, Fabio Cominelli Gastroenterology Volume 122, Issue 2, Pages 495-499 (February 2002) DOI: 10.1053/gast.2002.31387 Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 1 (A) Cutaneous necrosis of lower extremity. (B) Tc99m–labeled methylene diphosphonate full body bone scan showed diffuse increased uptake in the soft tissues of the bilateral calves and bilateral distal thighs (arrow). The above nonspecific findings can be seen in rhabdomyolysis, cellulitis, venous stasis, and diffuse myositis ossificans. Gastroenterology 2002 122, 495-499DOI: (10.1053/gast.2002.31387) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 2 (A) Purplish discoloration of the annular digit. (B) Hand radiographs showed extensive vascular calcification involving the radial and ulnar arteries as well as palmar and digital branches (arrows). Gastroenterology 2002 122, 495-499DOI: (10.1053/gast.2002.31387) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 4 Pathologic findings in H&E–stained histologic sections. (A) A skin biopsy showed vascular ectasia, hemorrhage, and scattered inflammatory cells in the superficial dermis (original magnification 100×). Several small blood vessels in this location showed fibrinoid necrosis of their walls (inset, original magnification 400×). (B) The adipose tissue deep to the dermis had fat necrosis and contained blood vessels with extensive mural calcification and intravascular thrombosis (original magnification 200×). (C) Partial colonic resection revealed extensive ischemic damage, including an area of transition from viable mucosa at the left, to an area of ischemic type ulceration to the right (original magnification 40×). The mucosal layer shows loss of epithelium with coagulative necrosis and hemorrhage of the lamina propria. Edema and vascular congestion is observed within the submucosa. (D) Several medium-sized to large blood vessels in the mesentery had extensive mural calcification (original magnification 40×).19 Gastroenterology 2002 122, 495-499DOI: (10.1053/gast.2002.31387) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 3 Abdominal CT scan showed free air within the peritoneal cavity (arrowhead), as well as extensive vascular calcification involving the aorta, renal arteries including the segmental branches, and mesenteric arterial branches (arrow). The hepatic and splenic arteries also showed extensive vascular calcification (not shown on this image). Gastroenterology 2002 122, 495-499DOI: (10.1053/gast.2002.31387) Copyright © 2002 American Gastroenterological Association Terms and Conditions