• mortality
• pneumatosis
• review
• venous gas

• Humans
• Portal Vein/diagnostic imaging
• Pneumatosis Cystoides Intestinalis/surgery
• Pneumatosis Cystoides Intestinalis/mortality
• Pneumatosis Cystoides Intestinalis/diagnostic imaging
• Mesenteric Ischemia/surgery
• Mesenteric Ischemia/mortality
• Mesenteric Ischemia/diagnostic imaging
• Embolism, Air/surgery
• Embolism, Air/mortality
• Embolism, Air/diagnostic imaging

• acute pancreatitis
• computed tomography
• hepatic portal venous gas
• management
• prognosis
• severity

• Hepatic portal venous gas
• Poor diagnosis
• Severe acute pancreatitis

Pneumatosis intestinalis or abnormal intramural gas within the digestive tract usually suggests bowel ischemia necessitating urgent surgery. We report the case of an 82-year-old female presenting with hypotension and nausea, with a past history of schizophrenia, low grade chronic lymphocytic leukemia, stroke, bronchitis and rheumatoid arthritis. Computed tomography performed demonstrated extensive submucosal gas within the entire small bowel, associated with free gas in the peritoneal cavity. Bowel ischemia was diagnosed radiologically. However, a benign diagnosis of fecal impaction was ultimately made due to the patient's stable clinical status. Clinical correlation and close monitoring of clinical status in this context is of greatest diagnostic assistance when encountered with this phenomenon, to prevent unnecessary harm to the patient.

• Bowel ischemia
• PMVG
• Pneumatosis intestinalis
• Porto-mesenteric venous gas
• Sepsis

• CECT, contrast-enhanced computed tomography
• CEUS, contrast-enhanced ultrasound
• CT, computed tomography
• Contrast-enhanced ultrasound
• ER, emergency room
• Liver blood flow
• PVG, portal vein gas
• Portal vein gas
• US, ultrasonography
• Ultrasound

• Diverticulitis
• fistulization
• portomesenteric venous gas

Portal venous gas (PVG) is common in necrotizing enterocolitis and occasionally occurs in neonates after umbilical vein catheterization (UVC). Therefore, determining the cause of PVG requires further clinical evaluation in these cases.

We report the case of a very‐low‐birth‐weight infant who underwent UVC after birth. PVG was an unexpected finding on ultrasound following catheterization. The UVC was immediately removed and replaced with a peripherally inserted central catheter. The infant’s physical examination was unremarkable. Bedside X‐ray revealed neither PVG nor pneumatosis intestinalis, which would indicate the onset of necrotizing enterocolitis. After full evaluation, breastfeeding was started on the same day. The infant did not develop feeding intolerance, necrotizing enterocolitis, or other disorders.

PVG occasionally occurs in neonates who undergo UVC and is considered to be caused by exogenous gases. PVG is more easily detected with ultrasound than with X‐ray and does not affect early feeding in premature infants.

• Early feeding
• Portal venous gas
• Umbilical vein catheterization
• Very low birth weight

• Biomarkers
• Diagnosis
• Intestinal fatty acid-binding protein
• Ischemia
• Pneumatosis intestinalis

• Adult
• Aged
• Area Under Curve
• Biomarkers/metabolism
• Cohort Studies
• Emergency Service, Hospital
• Fatty Acid-Binding Proteins/metabolism
• Female
• Humans
• Intestinal Diseases/mortality
• Intestinal Diseases/pathology
• Intestinal Diseases/surgery
• Intestine, Large/blood supply
• Intestine, Large/pathology
• Intestine, Small/blood supply
• Intestine, Small/pathology
• Ischemia/mortality
• Ischemia/pathology
• Ischemia/surgery
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Predictive Value of Tests
• Prognosis
• Registries
• Retrospective Studies
• Risk Assessment
• Survival Rate
• Treatment Outcome

To evaluate the clinical significance of pneumatosis intestinalis (PI) including the influence on treatment and outcome.

Two radiologists jointly reviewed MDCT-examinations of 149 consecutive emergency patients (53 women, mean age 64, range 21-95) with PI of the stomach (n = 4), small (n = 68) and/or large bowel (n = 96). PI extension, distribution and possibly associated porto-mesenteric venous gas (PMVG) were correlated with other MDCT-findings, risk factors, clinical management, laboratory, histopathology, final diagnosis and outcome.

The most frequent cause of PI was intestinal ischemia (n = 80,53.7 %), followed by infection (n = 18,12.1 %), obstructive (n = 12,8.1 %) and non-obstructive (n = 10,6.7 %) bowel dilatation, unknown aetiologies (n = 8,5.4 %), drugs (n = 8,5.4 %), inflammation (n = 7,4.7 %), and others (n = 6,4 %). Neither PI distribution nor extension significantly correlated with underlying ischemia. Overall mortality was 41.6 % (n = 62), mostly related to intestinal ischemia (p = 0.003). Associated PMVG significantly correlated with underlying ischemia (p = 0.009), as did the anatomical distribution of PMVG (p = 0.015). Decreased mural contrast-enhancement was the only other MDCT-feature significantly associated with ischemia (p p < 0.001). Elevated white blood count significantly correlated with ischemia (p = 0.03).

In emergency patients, ischemia remains the most common aetiology of PI, showing the highest mortality. PI with associated PMVG is an alerting sign. PI together with decreased mural contrast-enhancement indicates underlying ischemia.

• In emergency patients, PI may be caused by various disorders.

• Intestinal ischemia remains the most common cause of PI in acute situations.

• PI associated with decreased mural contrast-enhancement indicates acute intestinal ischemia.

• PI associated with PMVG should alert the radiologist to possible underlying ischemia.

• Intestinal ischemia
• Intestines
• Multidetector computed-tomography
• Pneumatosis intestinalis
• Portomesenteric venous gas

Hepatic portal venous gas (HPVG) is a rare but potentially lethal condition, especially when it results from intestinal ischemia. Since the literatures regarding the prognostic factors of HPVG are still scarce, we aimed to investigate the risk factor of perioperative mortality in this study.

We analyzed data for patients with intestinal ischemia induced HPVG by chart review in our hospital between 2000 and 2007. Factors associated with perioperative mortality were specifically analyzed.

There were 22 consecutive patients receiving definite bowel resection. 13 cases (59.1%) died after surgical intervention. When analyzing the mortality in patients after bowel resections, high Acute Physiology And Chronic health Evaluation (APACHE) II score (p < 0.01) and longer length of bowel resection (p = 0.047) were significantly associated with mortality in univariate analyses. The complication rate was 66.7% in alive patients after definite bowel resection.

Bowel resection was the only potential life-saving therapy for patients with mesenteric ischemia induced HPVG. High APACHE II score and severity of underlying necrotic bowel determined the results in patients after bowel resection.

Pneumatosis intestinalis has been increasingly detected in recent years with the more frequent use of computed tomography for abdominal imaging of the intestine. The underlying causes of the gas found during radiographic studies of the bowel wall can vary widely and different hypotheses regarding its pathophysiology have been postulated. Pneumatosis intestinalis often represents a benign condition and should not be considered an argument for surgery. However, it can also require life-threatening surgery in some cases, and this can be a difficult decision in some patients.

The spectrum of pneumatosis intestinalis is discussed here based on various computed tomographic and surgical findings in patients who presented at our University Medical Centre in 2003-2008. We have also systematically reviewed the literature to establish the current understanding of its aetiology and pathophysiology, and the possible clinical conditions associated with pneumatosis intestinalis and their management.

Pneumatosis intestinalis is a primary radiographic finding. After its diagnosis, its specific pathogenesis should be ascertained because the appropriate therapy is related to the underlying cause of pneumatosis intestinalis, and this is sometimes difficult to define. Surgical treatment should be considered urgent in symptomatic patients presenting with an acute abdomen, signs of ischemia, or bowel obstruction. In asymptomatic patients with otherwise inconspicuous findings, the underlying disease should be treated first, rather than urgent exploratory surgery considered. Extensive and comprehensive information on the pathophysiology and clinical findings of pneumatosis intestinalis is provided here and is incorporated into a treatment algorithm.

The information presented here allows a better understanding of the radiographic diagnosis and underlying aetiology of pneumatosis intestinalis, and may facilitate the decision-making process in this context, thus providing fast and adequate therapy to particular patients.

Portal vein gas is an ominous radiological sign, which indicates a serious gastrointestinal problem in the majority of patients. Many causes have been identified and the most important was bowel ischemia and mesenteric vascular accident. The presentation of patients is varied and the diagnosis of the underlying problem depends mainly on the radiological findings and clinical signs. The aim of this article is to show the clinical importance of portal vein gas and its management in emergency surgery.

A computerised search was made of the Medline for publications discussing portal vein gas through March 2008. Sixty articles were identified and selected for this review because of their relevance. These articles cover a period from 1975–2008.

Two hundreds and seventy-five patients with gas in the portal venous system were reported. The commonest cause for portal vein gas was bowel ischemia and mesenteric vascular pathology (61.44%). This was followed by inflammation of the gastrointestinal tract (16.26%), obstruction and dilatation (9.03%), sepsis (6.6%), iatrogenic injury and trauma (3.01%) and cancer (1.8%). Idiopathic portal vein gas was also reported (1.8%).

Portal vein gas is a diagnostic sign, which indicates a serious intra-abdominal pathology requiring emergency surgery in the majority of patients. Portal vein gas due to simple and benign cause can be treated conservatively. Correlation between clinical and diagnostic findings is important to set the management plan.

• Adolescent
• Adult
• Aged
• Algorithms
• Female
• Hospital Mortality
• Humans
• Logistic Models
• Male
• Middle Aged
• Pneumatosis Cystoides Intestinalis/diagnostic imaging
• Pneumatosis Cystoides Intestinalis/mortality
• Pneumatosis Cystoides Intestinalis/surgery
• Radiography
• Risk Factors

Ever since its earliest reports, portal venous gas (PVG) has been associated with numerous intraabdominal catastrophes and has served as an indication for urgent surgical exploration. It is traditionally regarded to be an ominous finding of impending death, with highest mortality reported in patients with underlying bowel ischemia. Today, computed tomography has demonstrated a wider range of clinical conditions associated with PVG, some of which are ‘benign’ and do not necessarily require surgery, unless when there are signs of intraabdominal catastrophe or systemic toxicity. One of these ‘benign’ conditions is Crohn’s disease. The present report describes a 19-year-old Chinese boy with Crohn’s pancolitis who presented with septic shock associated with PVG and portal vein thrombosis, and was successfully managed surgically. To our knowledge, this is the first report of PVG and portal vein thrombosis associated with Crohn’s disease in a Chinese patient. In addition, we have also reviewed the reports of another 18 Crohn’s patients with PVG previously described in the English literature. Specific predisposing factors for PVG were identified in 8 patients, including barium enema, colonoscopy, blunt abdominal trauma, and enterovenous fistula. The patients who developed PVG following barium enema and blunt trauma were all asymptomatic and no specific treatment was necessary. Eleven patients (58%) who presented with signs of intraabdominal catastrophe or systemic toxicity required either immediate or eventual surgery. The overall mortality rate among the 19 patients was only 11%. The present literature review has shown that the finding of PVG associated with Crohn’s disease does not always mandate surgical intervention. It is the clinical features and the related complications that ultimately determine the treatment approaches. The overall outcome of PVG associated with Crohn’s disease has been favourable.

• Portal venous gas
• Portal vein thrombosis
• Pylephlebitis
• Crohn’s disease
• Chinese

• Adult
• Colitis/complications
• Colitis/pathology
• Crohn Disease/complications
• Crohn Disease/pathology
• Embolism, Air/etiology
• Embolism, Air/surgery
• Humans
• Male
• Portal Vein/pathology
• Venous Thrombosis/etiology
• Venous Thrombosis/pathology
• Venous Thrombosis/surgery

• Aged
• Aged, 80 and over
• Embolism, Air/diagnostic imaging
• Female
• Gases
• Humans
• Male
• Mesenteric Veins/diagnostic imaging
• Middle Aged
• Portal Vein/diagnostic imaging
• Prognosis
• Survival Rate
• Tomography, X-Ray Computed
• Ultrasonography

• Aged, 80 and over
• Atrial Fibrillation/complications
• Embolism, Air/diagnostic imaging
• Embolism, Air/etiology
• Female
• Humans
• Ileal Diseases/complications
• Ileal Diseases/diagnostic imaging
• Ileal Diseases/pathology
• Ileal Diseases/surgery
• Liver Diseases/diagnostic imaging
• Liver Diseases/etiology
• Necrosis
• Portal System/diagnostic imaging
• Radiography
• Treatment Outcome

• Abdomen/diagnostic imaging
• Abdominal Pain/etiology
• Acute Disease
• Female
• Humans
• Infarction/diagnosis
• Infarction/surgery
• Intestines/blood supply
• Intestines/surgery
• Ischemia/diagnosis
• Ischemia/surgery
• Liver/diagnostic imaging
• Mesenteric Arteries/diagnostic imaging
• Mesenteric Vascular Occlusion/diagnosis
• Middle Aged
• Portal Vein/diagnostic imaging
• Radiography, Abdominal/methods
• Radiography, Thoracic/methods
• Ultrasonography