Abstract
Hepatic portal venous gas (HPVG) is a rare radiographic finding of significance. Most
cases with HPVG are related to mesenteric ischemia that have been associated with
extended bowel necrosis and fatal outcome. With the help of computed tomography (CT)
in early diagnosis of HPVG, the clinical outcome of patients with mesenteric ischemia
has improved. There has been also an increasing rate of detection of HPVG with certain
nonischemic conditions. In this report, we present two cases demonstrating HPVG unrelated
to mesenteric ischemia. One patient with cholangitis presented abdominal pain with
local peritonitis and survived after appropriate antibiotic treatment. Laparotomy
was avoided as a result of lack of CT evidence of ischemic bowel disease besides the
presence of HPVG. The other case had severe enteritis. Although his CT finding preluded
ischemic bowel disease, conservative treatment was implemented because of the absence
of peritoneal signs or clinical toxic symptoms. Therefore, whenever HPVG is detected
on CT, urgent exploratory laparotomy is only mandatory in a patient with whom intestinal
ischemia or infarction is suspected on the basis of radiologic and clinical findings.
On the other hand, unnecessary exploratory laparotomy should be avoided in nonischemic
conditions that are usually associated with a better clinical outcome if appropriate
therapy is prompted for the underlying diseases. Patients with radiographic diagnosis
of HPVG should receive a detailed history review and physical examination. The patient’s
underlying condition should be determined to provide a solid ground for exploratory
laparotomy. A flow chart is presented for facilitating the management of patients
with HPVG in the ED.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Portal-venous gas unrelated to mesenteric ischemia.Eur Radiol. 2002; 12: 1432-1437
- Case records of the LeBonheur children’s medical center.Pediatr Emerg Care. 1997; 13: 237-242
- Pneumatosis cystoids intestinalis and portal venous air.Ann Emerg Med. 1998; 31: 286-287
- Portal venous gas.J Emerg Med. 2000; 18: 105-107
- Portal vein air embolization after blunt abdominal trauma.Eur J Emerg Med. 2002; 9: 163-165
- Portomesenteric vein gas.Radiographics. 2000; 20: 1213-1224
- Sonographic detection of portal venous gas in infants with necrotizing enterocolitis.AJR Am J Roentgenol. 1984; 143: 1059-1062
- Hepatic portal venous gas.Acta Radiol. 1995; 36: 377-380
- Gas in the portal veins of the liver in infants.AJR Am J Roentgenol. 1955; 74: 486-489
- Gas embolization of the portal venous system.AJR Am J Roentgenol. 1960; 83: 847-850
- Portal vein gas, a changing clinical entity.Arch Surg. 1997; 132: 1071-1075
- Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia.AJR Am J Roentgenol. 2001; 177: 1319-1323
- Outcome of 17 patients with portal venous gas detected by CT.AJR Am J Roentgenol. 1997; 169: 1535-1538
- CT detection of portal venous gas associated with suppurative cholangitis and cholecystitis.AJR Am J Roentgenol. 1985; 145: 1017-1018
- Sonographic detection of hepatic portal venous gas associated with suppurative conlangiits.J Clin Ultrasound. 1993; 21: 331-334
- Portal vein gas associated with rotavirus infection.J Pediatr Gastroenterol Nutr. 2001; 33: 626-628
- Computerized tomography detection of portal vein air accumulation in severe gastroenteritis during chemotherapy.Wien Klin Wochenschr. 2000; 112: 80-83
- Necrotizing Candida enterocolitis in AIDS.J Comput Assist Tomogr. 1994; 18: 298-300
- Hepatic portal vein gas following blunt colon injury.J Formos Med Assoc. 1995; 94: 578-580
- Portal vein gas and colonic pneumatosis after enema, with spontaneous resolution.AJR Am J Roentgenol. 1999; 173: 1140-1141
- Traumatic pneumatosis cystoides intestinalis with portal venous air embolism.J Trauma. 1997; 42: 112-114
- Pneumatosis intestinalis and portal vein gas after blunt abdominal trauma.J Pediatr Surg. 1998; 3: 1309-1311
Article Info
Publication History
Accepted:
May 6,
2003
Received:
May 6,
2003
Identification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
