{'fraction_non_alphanumeric': 0.03975058456742011, 'fraction_numerical': 0.012470771628994544, 'mean_word_length': 5.294117647058823, 'pattern_counts': {'":': 0, '<': 1, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 1, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
A rare cause of diffuse abdominal pain and fullness in a 57-year-old man.

Question: A 57-year-old man presented with 2-week history of progressive diffuse abdominal pain and fullness that was not associated with nausea or vomiting. He also had body weight loss and 1-week history of constipation. The only significant past medical history was hypertension; there was no significant surgical history. Physical examination showed a distended abdomen with diffuse tenderness. Bowel sound was reduced. Laboratory tests were unremarkable (including autoimmune disorders and hypercoagulable states) other than a high C-reactive protein (CRP) level of 5.85 mg/dL (normal, <0.5) and erythrocyte sedimentation rate of 48 mm/h (normal, 0–20). Esophagogastroduodenoscopy was negative but colonoscopy revealed engorged veins at the hepatic flexure (Figure A). Abdominal computed tomography (CT) showed increased fat attenuation along the mesenteric root regions, enlarged mesenteric lymph nodes, pseudotumor stripe (Figure B), and thrombus within the confluence of main portal and superior mesenteric vein (Figure C). What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.