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Mollah T, Zhang X, Kuany T, Onasanya O, Knowles B. Hepatic Portal Venous Gas in Acute Pancreatitis-A Critical Finding: A Systematic Review. Am Surg 2025:31348251338383. [PMID: 40277381 DOI: 10.1177/00031348251338383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2025]
Abstract
BackgroundHepatic portal venous gas (HPVG) is an uncommon radiological finding in acute pancreatitis. This systematic review aims to consolidate existing literature on HPVG in acute pancreatitis and assess its clinical significance, particularly regarding surgical intervention. We also report a clinical case from our center.MethodsA systematic search was conducted across Medline, Scopus, Cochrane, and Google Scholar databases to identify studies reporting concurrent HPVG and pancreatitis. Data included demographics, clinical presentation, management, and outcomes. Descriptive statistics were employed for analysis, and methodological quality was assessed using established criteria.ResultsOut of 259 articles screened, 13 met inclusion criteria, yielding data on 17 patients (76.5% male; median age 62 years). Nonoperative management (NOM) was utilized in 75% of cases and was associated with a 54% mortality rate. In contrast, the surgical cohort (n = 4) experienced a similar overall mortality rate of 50%. Importantly, necrotic bowel was implicated in 44% of evaluable cases and was uniformly fatal. However, 2 patients who underwent early surgical resection of nonviable bowel survived the initial phase of their illness, suggesting that prompt operative intervention may confer an early survival advantage in selected patients. Fluid collections and pneumatosis intestinalis were significantly more prevalent in deceased patients (100% vs 17% in survivors; P < 0.0034). All deceased patients had either severe or necrotizing pancreatitis.ConclusionHPVG associated with severe acute pancreatitis appears to have a higher mortality than HPVG alone. It can be managed nonoperatively but when indicative of bowel necrosis, necessitates prompt surgical intervention.
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Affiliation(s)
- Taha Mollah
- Department of UGI and HPB Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Xingyi Zhang
- Department of UGI and HPB Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Thiep Kuany
- Department of UGI and HPB Surgery, Western Health, Melbourne, VIC, Australia
| | - Olukunle Onasanya
- Department of UGI and HPB Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Brett Knowles
- Department of UGI and HPB Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
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Yoshida N, Sadakari Y, Nakane H, Yoshitomi M, Tamehiro K, Hirokata G, Aoyagi T, Ogata T, Taniguchi M. Extrahepatic Portal Venous Gas Is the Strongest Predictor of Mortality in Patients with Portal Venous Gas and Pneumatosis Intestinalis. Kurume Med J 2024; 70:121-130. [PMID: 39098029 DOI: 10.2739/kurumemedj.ms7034005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
BACKGROUND Very few studies have examined the association between contrast-enhanced computed tomography (CT) findings observed in portal venous gas (PVG) and pneumatosis intestinalis (PI) and the underlying diseases in these conditions. OBJECTIVES In this study, we analyzed this association and report the findings for predicting mortality. MATERIALS AND METHODS Overall, 50 patients diagnosed with PVG or PI, observed on contrast-enhanced CT, underwent treatment at our hospital. Based on the underlying disease, we divided the patients into three groups, those with ischemic disease, infectious disease, or gastrointestinal dilatation. Furthermore, cases that underwent surgical treatment or needed surgery but were inoperable were assigned to the high risk group (n=16) and patients who received conservative treatment were assigned to the low risk group (n=34). We reviewed the patients' medical charts, laboratory data, and CT images retrospectively, and analyzed the relationship between CT findings, underlying disease, and association with the high risk or low risk group in each case. RESULTS Poor enhancement of the intestinal wall, mesenteric fat stranding, extrahepatic PVG, advanced age, and renal disease were significantly associated with ischemic disease (p=0.02, p=0.02, p=0.005, p=0.008 and p=0.049, respectively). PI alone was strongly associated with gastrointestinal dilatation (p=0.009). Patients in the low risk group had more favorable outcomes with conservative treatment. In multivariate analysis, extrahepatic PVG was the only factor associated with the high risk group (p=0.002). CONCLUSION Extrahepatic PVG associated with ischemic disease was the strongest predictive factor of mortality. Other CT findings, though useful in diagnosing the underlying disease, were not significant predictive factors.
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3
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Bitar R, Langdon J, Kaur M, Crandall I, McNamara R, Revzin M. Residual Ultrasound-Enhancing Agents Mimicking Portal Venous Gas. Ultrasound Q 2024; 40:e00694. [PMID: 39466239 DOI: 10.1097/ruq.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2024]
Abstract
ABSTRACT Sonographic detection of mobile echogenic foci within the main portal vein and its branches or within the liver parenchyma extending along the portal triads to the periphery of the liver is an alarming finding that has been associated with portal venous gas in the setting of bowel ischemia. Ultrasound-enhancing agents (UEAs) have been widely utilized in abdominal ultrasound for evaluation of organ neoplasms and vascular patency as well as in echocardiography for the evaluation of cardiac function. The appearance of UEAs on abdominal ultrasound can resemble gas like that seen in the portal venous system and liver in patients with bowel ischemia; therefore, UEA residuals should always be a part of the differential diagnosis of echogenic foci when seen on abdominal ultrasounds with preceding recent UEA administration. In this observational study, we present a series of cases with suspected portal venous gas suspicious for bowel ischemia that turned out to be a result of residual or persistent UEA from the recent contrast-enhanced echocardiography. Discussion of this phenomenon and its potential explanation is provided.
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Affiliation(s)
- Ryan Bitar
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Jonathan Langdon
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Manroop Kaur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Ian Crandall
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Robert McNamara
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Margarita Revzin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
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Harada K, Fujikawa T, Uemoto Y, Kawamura Y. Gangrenous Cholecystitis Secondary to Pneumatosis Intestinalis and Portal Venous Gas: A Case Report. Cureus 2024; 16:e71128. [PMID: 39539918 PMCID: PMC11559320 DOI: 10.7759/cureus.71128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2024] [Indexed: 11/16/2024] Open
Abstract
Pneumatosis intestinalis (PI) and portal venous gas (PVG) are pathological conditions suggesting serious underlying diseases such as intestinal ischemia, intestinal wall infarction, and necrotizing enterocolitis. Therefore, early detection, comprehensive management, and timely treatment of the underlying disease are important for improving outcomes. We experienced a case of a patient who developed gangrenous cholecystitis secondary to PI and PVG. In this case, it was suggested that gangrenous cholecystitis may have been induced by retrograde infection due to the proliferation of intestinal bacteria and increased intestinal pressure caused by the reduced intestinal peristalsis due to PI and PVG. Herein, we report the successful treatment of this case with a literature review.
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Affiliation(s)
- Kei Harada
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
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Bitar R, Kaur M, Crandall I, McNamara R, Revzin MV. Ultrasound evaluation of portal venous gas and its mimics. Abdom Radiol (NY) 2024; 49:2756-2769. [PMID: 38735019 DOI: 10.1007/s00261-024-04328-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024]
Abstract
Portal venous gas on abdominal ultrasound classically represents an indirect indicator of bowel ischemia, a critical condition which poses a high patient mortality and therefore warrants emergent corrective action. While the classic appearance of portal venous gas on ultrasound is well-described in the literature, the characteristic descriptors are nonspecific and may actually represent other less emergent mimics. Therefore, while radiologists should remain vigilant for the detection of findings corresponding to portal venous gas, they should also be aware of similar-appearing entities in order to provide the most accurate diagnosis. This pictorial essay will open with imaging examples of true portal venous gas attributable to bowel ischemia and describe the classic features which should alert radiologists to this specific diagnosis. Subsequently, this pictorial essay will provide imaging examples of other various other clinical entities which on ultrasound may share similar imaging characteristics. An important objective of this pictorial essay is to highlight distinguishing imaging features along with specific clinical circumstances for each pathological entity which can direct radiologists into identifying the correct diagnosis.
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Affiliation(s)
- Ryan Bitar
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Manroop Kaur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Ian Crandall
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert McNamara
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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Lugue MT, Cruz G, Jones DT, Heer MS, Bui L, Pace C, Silver SA. Severe Pneumatosis Intestinalis and Hepatic Portal Venous Gas in a Patient With Methamphetamine Use: Early Recognition and Management. Cureus 2024; 16:e68017. [PMID: 39211828 PMCID: PMC11361326 DOI: 10.7759/cureus.68017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 09/04/2024] Open
Abstract
Pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) are rare but potentially life-threatening conditions characterized by the presence of gas within the bowel wall and portal venous system, respectively. This case report presents a 45-year-old male with a history of methamphetamine use who developed severe metabolic and hemodynamic instability, marked by altered mental status, metabolic acidosis, and ST elevations. Despite aggressive resuscitation and intensive care, the patient unfortunately succumbed to his condition, highlighting the gravity of these complications. This report underscores the importance of early recognition, comprehensive management, and timely surgical consultation to improve outcomes. It also emphasizes the need for a multidisciplinary approach and further research to better understand these conditions and the significant role of methamphetamine use as a contributing factor.
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Affiliation(s)
| | - Gabriel Cruz
- Internal Medicine, Touro University Nevada, Henderson, USA
| | - Daniel T Jones
- Internal Medicine, Touro University Nevada, Henderson, USA
| | - Manvir S Heer
- Internal Medicine, Kansas City University, Joplin, USA
| | - Linsey Bui
- Internal Medicine, Valley Hospital Medical Center Internal Medicine Residency Program, Las Vegas, USA
| | - Christopher Pace
- Internal Medicine, Valley Hospital Medical Center Internal Medicine Residency Program, Las Vegas, USA
| | - Scott A Silver
- Internal Medicine, Valley Hospital Medical Center Internal Medicine Residency Program, Las Vegas, USA
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Wang C, Jin H, Xue H, Zhang Y. Intrahepatic Gas Caused by Acute Gastroenteritis: Hepatic Portal Venous Gas or Biliary Tract Gas? Int Med Case Rep J 2024; 17:589-592. [PMID: 38863571 PMCID: PMC11166165 DOI: 10.2147/imcrj.s468694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/25/2024] [Indexed: 06/13/2024] Open
Abstract
Purpose Hepatic portal venous gas is not a specific disease and is often only an imaging manifestation in patients with acute abdomen. However, its appearance often indicates serious disease and poor prognosis. It is not difficult to distinguish typical portal venous gas from biliary tract gas on computed tomography because of their relatively different distribution within the liver. But the difference is not absolute. Case Description An 82-year-old female was admitted to the emergency department due to epigastric pain, nausea and vomiting for 1 day. Intrahepatic gas was found on computed tomography (CT), which was initially diagnosed as portal venous gas, and contrast-enhanced abdominal CT was performed 3 hours after the first plain CT scan and revealed a significant reduction of intrahepatic gas, then diagnosed as biliary tract gas. Two days later, enhanced abdominal CT showed that biliary tract gas had disappeared. Continuous gastrointestinal decompression, anti-infection, rehydration and other treatments were given. After treatment, abdominal pain, nausea, vomiting and other symptoms of the patient were gradually relieved. The patient refused gastroenteroscopy and was discharged after 13 days of hospitalization. Conclusion Portal venous gas and biliary tract gas may have similar CT findings and be misdiagnosed, and enhanced CT examination is necessary to confirm the diagnosis.
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Affiliation(s)
- Chunhua Wang
- Department of Gastroenterology, Bethune International Peace Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Haifeng Jin
- Department of Gastroenterology, Bethune International Peace Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Hua Xue
- Department of Gastroenterology, Bethune International Peace Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Yanwei Zhang
- Department of Diagnostic Radiology, Bethune International Peace Hospital, Shijiazhuang, Hebei, People’s Republic of China
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Pierce TT, Prabhu V, Baliyan V, Hedgire S. Imaging of Visceral Vessels. Radiol Clin North Am 2024; 62:543-557. [PMID: 38553185 DOI: 10.1016/j.rcl.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The visceral vasculature is inextricably intertwined with abdominopelvic disease staging, spread, and management in routine and emergent cases. Comprehensive evaluation requires specialized imaging techniques for abnormality detection and characterization. Vascular pathology is often encountered on nondedicated routine imaging examinations, which may obscure, mimic, or confound many vascular diagnoses. This review highlights normal arterial, portal venous, and systemic venous anatomy and clinically relevant variants; diagnostic pitfalls related to image-acquisition technique and disease mimics; and characteristics of common and rare vascular diseases to empower radiologists to confidently interpret the vascular findings and avoid misdiagnosis.
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Affiliation(s)
- Theodore T Pierce
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, White Building, Room 270, 55 Fruit Street, Boston, MA 02114, USA.
| | - Vinay Prabhu
- Department of Radiology, NYU Langone Health, 660 First Avenue, Third Floor, New York, NY 10016, USA
| | - Vinit Baliyan
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital-Harvard Medical School, 175 Cambridge Street, Boston, MA 02114, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital-Harvard Medical School, 175 Cambridge Street, Boston, MA 02114, USA
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9
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Kubo K, Ashida I, Kimura N. Ulcerated Stenosis of the Small Intestine Associated With Hepatic Portal Venous Gas After Treatment for Cytomegalovirus Enteritis: A Case Report. Cureus 2024; 16:e59495. [PMID: 38826957 PMCID: PMC11143396 DOI: 10.7759/cureus.59495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
Due to its rarity, cytomegalovirus (CMV) enteritis remains poorly described with regard to its endoscopic and radiological findings. A 75-year-old woman was admitted to our hospital with abdominal pain and was treated with an antiviral agent for CMV enteritis. She was readmitted to our hospital 10 days after discharge due to a recurrence of abdominal pain. Emergency computed tomography revealed hepatic portal venous gas (HPVG) and ileal dilatation involving focal stenosis of the ileum. The patient underwent laparoscopic partial resection of the small intestine and was finally diagnosed with ulcered stenosis of the small intestine after treatment for CMV enteritis. This report represents a valuable addition to the literature describing a rare case of ulcerated stenosis of the small intestine associated with HPVG after treatment for CMV enteritis.
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Affiliation(s)
- Kimitoshi Kubo
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, JPN
| | - Issei Ashida
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, JPN
| | - Noriko Kimura
- Department of Pathology, National Hospital Organization Hakodate National Hospital, Hakodate, JPN
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10
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Hisata Y, Katsuki NE, Tago M, Nishi T, Nakashima T, Oda Y, Yamashita SI. Potential Indicators of Intestinal Necrosis in Portal Venous Gas: A Case Report of an 82-Year-Old Woman on Long-Term Hemodialysis with Ascites and Pneumatosis Coli. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942966. [PMID: 38635487 DOI: 10.12659/ajcr.942966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND Several factors have been reported as possible predictors of intestinal necrosis in patients with portal venous gas (PVG). We describe potential indicators of intestinal necrosis in PVG identified by contrasting 3 episodes of PVG in a patient on hemodialysis against previously verified factors. CASE REPORT An 82-year-old woman undergoing hemodialysis was admitted to our hospital thrice for acute abdominal pain. On first admission, she was alert, with a body temperature of 36.3°C, blood pressure (BP) of 125/53 mmHg, pulse rate of 60/min, respiratory rate of 18/min, and 100% oxygen saturation on room air. Computed tomography (CT) revealed PVG, intestinal distension, poor bowel wall enhancement, bubble-like pneumatosis in the intestinal wall, and minimal ascites. PVG caused by intestinal ischemia was diagnosed, and she recovered after bowel rest and hydration. Three months later, she had a second episode of abdominal pain. BP was 115/56 mmHg. CT revealed PVG and a slight accumulation of ascites, without pneumatosis in the intestinal wall. She again recovered after conservative measures. Ten months later, the patient experienced a third episode of abdominal pain, with BP of 107/52 mmHg. CT imaging indicated PVG, considerable ascites, and linear pneumatosis of the intestinal walls. Despite receiving conservative treatment, the patient died. CONCLUSIONS A large accumulation of ascites and linear pneumatosis in the intestinal walls could be potential indicators of intestinal necrosis in patients with PVG caused by intestinal ischemia. As previously reported, hypotension was further confirmed to be a reliable predictor of intestinal necrosis.
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Affiliation(s)
- Yoshio Hisata
- Department of General Medicine, Saga University Hospital, Saga, Japan
- Department of Internal Medicine, Nagahama City Kohoku Hospital, Nagahama, Shiga, Japan
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Tomoyo Nishi
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | | | - Yoshimasa Oda
- Department of General Medicine, Saga University Hospital, Saga, Japan
- Department of General Medicine, Yuai-Kai Foundation and Oda Hospital, Saga, Japan
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11
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Liu A, Shen J, Long L, Shi X, Wen Q, Pan Z. Hepatic portal venous gas initially manifesting as severe shock: a case series. J Int Med Res 2024; 52:3000605241239469. [PMID: 38603615 PMCID: PMC11010767 DOI: 10.1177/03000605241239469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/28/2024] [Indexed: 04/13/2024] Open
Abstract
Hepatic portal venous gas is often referred to as the "sign of death" because it signifies a very poor prognosis if appropriate treatments are not promptly administered. The etiologies of hepatic portal venous gas are diverse and include severe complex abdominal infections, mesenteric ischemia, diving, and complications of endoscopic surgery, and the clinical manifestations are inconsistent among individual patients. Thus, whether emergency surgery should be performed remains controversial. In this report, we present three cases of hepatic portal venous gas. The patients initially exhibited symptoms consistent with severe shock of unknown etiology and were treated in the intensive care unit upon admission. We rapidly identified the cause of each individual patient's condition and selected problem-directed intervention measures based on active organ support, antishock support, and anti-infection treatments. Two patients recovered and were discharged without sequelae, whereas one patient died of refractory infection and multiple organ failure. We hope that this report will serve as a valuable reference for decision-making when critical care physicians encounter similar patients.
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Affiliation(s)
- Anwei Liu
- Department of Intensive Care Unit, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Jiao Shen
- Department of Intensive Care Unit, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Liansheng Long
- Department of General Surgery, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Xuezhi Shi
- Department of Intensive Care Unit, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Qiang Wen
- Department of Intensive Care Unit, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Zhiguo Pan
- Emergency Department, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
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12
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Chen L, Zhi W, Huang S, Wang J. A Nomogram for Predicting Surgical Risk in Neonates with Necrotizing Enterocolitis: A Retrospective Cohort Study. Indian J Pediatr 2024:10.1007/s12098-024-05091-4. [PMID: 38557821 DOI: 10.1007/s12098-024-05091-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To construct a nomogram that predicts the risk of surgery in patients with necrotizing enterocolitis (NEC). METHODS This retrospective cohort study recruited patients diagnosed with NEC at the Children's Hospital of Soochow University from 2013 to 2023. The neonates were divided into conservative and surgical-treatment groups. Univariate and multivariate logistic regressions were performed to identify factors influencing surgical risk, and a predictive model was constructed. RESULTS This study comprised 154 cases of NEC, 103 cases (66.9%) in the conservative group and 51 cases (33.1%) in the surgical group. Multivariate logistic regression analysis revealed that increased bloody stools [odds ratio (OR) 5.066; 95% confidence interval (CI) 1.7396-14.7532; p = 0.0029), oxygen inhalation (OR 1.8278; 95% CI 1.2113-2.7581; p = 0.0041), use of vasoconstrictors (OR 4.4446; 95% CI 1.7157-11.5137; p = 0.0021), portal venous gas (OR 4.5569; 95% CI 1.6324-12.7209; p = 0.0038), and blood sodium (OR 0.8339; 95% CI 0.7477-0.9301; p = 0.0011) were independent factors of surgical risk. The area under the nomogram's receiver operating characteristic (ROC) curve was 0.886. Decision curve analysis (DCA) and calibration curves demonstrated good predictive performance for the nomogram. CONCLUSIONS The nomogram effectively assessed the risk of surgical intervention in NEC patients, providing new insights and references for diagnosing and treating NEC.
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Affiliation(s)
- Lulu Chen
- Department of Surgery, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Wenxian Zhi
- Department of Surgery, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Shungen Huang
- Department of Surgery, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Jian Wang
- Department of Surgery, Children's Hospital of Soochow University, Suzhou, 215025, China.
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13
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Wong NLJ, Paredes SR, Seyfi D, Ng KS. Outcomes of patients with pneumatosis intestinalis and/or portal venous gas: a study of factors associated with survival and surgical intervention. ANZ J Surg 2024; 94:640-647. [PMID: 38263543 DOI: 10.1111/ans.18875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUNDS This study investigated the incidence of, and mortality and management outcomes following, pneumatosis intestinalis and/or portal venous gas on computed tomography. METHODS A retrospective study of patients identified with pneumatosis intestinalis and/or portal venous gas on computed tomography at a quaternary centre (2013-2021) was performed. Data relating to clinical presentation (including quick sequential organ failure assessment score), co-morbidities (Charlson Comorbidity Index), biochemical data (including peak lactate level), and radiological findings, were obtained. Factors associated with these were assessed by logistic regression. RESULTS From 16 428 scans, 107 (0.65%) demonstrated pneumatosis intestinalis and/or portal venous gas (mean 65.2 years [SD 15.2]; 60 [56%] male). Overall, 37 patients (35%) had both findings present. Thirty-three deaths (31%) were recorded. Fifty-four patients (51%) underwent surgery. Death was associated with quick sequential organ failure assessment score (score 1: OR 5.71, 95% CI 1.31-24.87; score 2: OR 10.00, 95% CI 1.94-51.54), Charlson Comorbidity Index ≥5 (OR 2.86, 95% CI 1.19-6.84), peak lactate ≥2.6 mmol/L (OR 14.53, 95% CI 4.39-48.14), and concomitant pneumatosis intestinalis and portal venous gas (OR 8.25, 95% CI 3.04-22.38). The presence of free peritoneal fluid (OR 3.23, 95% CI 1.44-7.28) or perforated viscus (OR 5.10, 95% CI 1.05-24.85) were the only predictors for surgery. CONCLUSION Pneumatosis intestinalis and portal venous gas are rare findings. Despite traditionally portending a poor prognosis, mortality occurred in only one-third of patients. There were clear indicators of mortality viz. sepsis severity, comorbidities, and concomitant pneumatosis intestinalis and portal venous gas. Factors predicting surgery warrant further investigation.
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Affiliation(s)
- Ngar Lok Joshua Wong
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Steven Ronald Paredes
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Doruk Seyfi
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kheng-Seong Ng
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Concord Institute of Academic Surgery, Concord Hospital, Concord, New South Wales, Australia
- Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
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14
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Carlone G, Dubuis JB, Sgardello SD, Gussago S, Fournier I. Successful Conservative Management of Hepatic Portal Venous Gas Following Percutaneous Endoscopic Gastrostomy: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942721. [PMID: 38327038 PMCID: PMC10862080 DOI: 10.12659/ajcr.942721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/29/2023] [Accepted: 12/14/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Hepatic portal venous gas (HPVG) is a rare radiologic finding mostly associated with life-threatening diseases like bowel necrosis, but can also be benign; its overall mortality rate is 39-75%. In rare cases HPVG is associated with endoscopic procedures such as percutaneous endoscopic gastrostomy (PEG) placement. However, due to the rarity of this condition, there is no recommendation about its management. The aim of this case report was to describe a successful conservative management of HPVG without antibiotic administration based on the clinical presentation. CASE REPORT A 78-year-old male patient known for a history of esophageal cancer treated with radio- and chemotherapy, complicated by a post-radiation esophageal stenosis requiring a PEG tube placement 1 month prior was admitted to our Emergency Department for vomiting and abdominal pain. A contrast-enhanced abdominal CT scan showed small-bowel dilatation without obstruction, as well as gastric wall pneumatosis and HPVG. We opted for a conservative approach. The PEG was put to suction for 2 days. The clinical evolution was favorable, with resolution of abdominal pain and a restored transit on day 2. A follow-up CT scan at day 5 showed resolution of HPVG. Nutrition through the PEG was restored at day 6 without complication. CONCLUSIONS HPVG can be a benign finding after a PEG tube placement. Conservative management without antibiotics can be used in oligosymptomatic and hemodynamically stable patients after life-threatening associated diseases like bowel necrosis have been ruled out.
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Affiliation(s)
- Giovanni Carlone
- Department of General and Visceral Surgery, Sion Hospital, Sion, Switzerland
| | - Jean-Baptiste Dubuis
- Department of General and Visceral Surgery, Sion Hospital, Sion, Switzerland
- Department of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
| | | | - Stefano Gussago
- Department of General and Visceral Surgery, Sion Hospital, Sion, Switzerland
- Department of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Ian Fournier
- Department of General and Visceral Surgery, Sion Hospital, Sion, Switzerland
- Department of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
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Dogaru IA, Gheoca Mutu DE, Ursuț BM, Filipoiu FM, Tulin AD. Decoding Hepatic Portal Venous Gas: A Case Report. Cureus 2024; 16:e54050. [PMID: 38481931 PMCID: PMC10934107 DOI: 10.7759/cureus.54050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 11/02/2024] Open
Abstract
Hepatic portal venous gas (HPVG) is an infrequent and life-threatening condition with high morbidity and mortality rates, which consists of the presence of gas in the portal vein and its branches. Improvements in imaging technologies have led to the diagnosis of HPVG in less severe circumstances, which, in turn, has only determined a small amelioration of the prognosis. We present a rare case of HPVG subsequent to paralytic ileus in a patient who attained long-term survival after the surgical treatment was performed. HPVG is considered to be associated with sepsis, parietal/mucosal damage, inflammation of the intraperitoneal organs, and meteorism, which may be found in a variety of pathologies. The severity of this pathology depends on the pre-existing conditions of the patients but also on how quickly a treatment plan is established and applied. As a correct and timely diagnosis is crucial for the increase of the survival rate in HPVG, greater attention shall be paid to the clinical manifestations and the differential diagnosis.
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Affiliation(s)
- Iulian A Dogaru
- Discipline of Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Clinical Department of General Surgery, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest, ROU
| | - Daniela E Gheoca Mutu
- Discipline of Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Clinical Department of Plastic and Aesthetic Surgery and Reconstructive Microsurgery, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest, ROU
| | - Bogdan M Ursuț
- Discipline of Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Clinical Department of General Surgery, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest, ROU
| | - Florin M Filipoiu
- Discipline of Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Adrian D Tulin
- Discipline of Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Clinical Department of General Surgery, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest, ROU
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16
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Furuta T, Fujiwara M, Motonaga T, Matsufuji H, Tateishi H, Nakada S, Kanagawa T, Uchida M. Ultrasound and computed tomography findings of hepatic portal venous gas associated with acute appendicitis in a paediatric patient: A case report. ULTRASOUND (LEEDS, ENGLAND) 2024; 32:67-70. [PMID: 38314018 PMCID: PMC10836226 DOI: 10.1177/1742271x231195752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/24/2023] [Indexed: 02/06/2024]
Abstract
Introduction Hepatic portal venous gas is a rare and life-threatening condition characterised by the presence of gas in the portal vein. Hepatic portal venous gas is frequently associated with intestinal ischaemia and necrosis. We present the case of a paediatric patient with acute appendicitis with hepatic portal venous gas detected using ultrasonography. Case report A 5-year-old boy was admitted to our hospital with a respiratory tract infection. The boy started vomiting on day 2 of hospitalisation. He did not complain of any symptoms due to developmental retardation. We performed bedside point-of-care ultrasound, which detected hepatic portal venous gas, although the appendix could not be detected due to an acoustic shadow associated with bowel gas. Contrast-enhanced computed tomography revealed perforated appendicitis and pneumatosis intestinalis associated with paralytic ileus. An emergency laparoscopic appendectomy was performed. He was discharged on day 25 of hospitalisation after antibiotic therapy. Discussion The present case suggests that the mechanism of hepatic portal venous gas was paralytic ileus, which caused gas-forming bacterial proliferation. The gas produced by bacteria and/or the gas-forming bacteria entered the bowel wall, which caused pneumatosis intestinalis. The bubbles in the intestinal wall floated in the portal system and were detected as hepatic portal venous gas. Perforated appendicitis and paralytic ileus seemed to be caused by a delayed diagnosis of appendicitis. The point-of-care ultrasound examination was useful for detecting hepatic portal venous gas and for helping establish the diagnosis of appendicitis. Conclusion Hepatic portal venous gas is a rare finding associated with appendicitis in children. In addition, point-of-care ultrasound is useful for detecting hepatic portal venous gas in paediatric patients.
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Affiliation(s)
- Takashi Furuta
- Department of Pediatrics, Tokuyama Central Hospital, Japan Community Healthcare Organization, Shunan, Japan
| | - Mayu Fujiwara
- Department of Pediatrics, Tokuyama Central Hospital, Japan Community Healthcare Organization, Shunan, Japan
| | - Takahiro Motonaga
- Department of Pediatrics, Tokuyama Central Hospital, Japan Community Healthcare Organization, Shunan, Japan
| | - Hironori Matsufuji
- Department of Pediatrics, Tokuyama Central Hospital, Japan Community Healthcare Organization, Shunan, Japan
| | - Hiroshi Tateishi
- Department of Pediatrics, Tokuyama Central Hospital, Japan Community Healthcare Organization, Shunan, Japan
| | - Soichi Nakada
- Department of Pediatric Surgery, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Tsutomu Kanagawa
- Department of Pediatric Surgery, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Masashi Uchida
- Department of Pediatrics, Tokuyama Central Hospital, Japan Community Healthcare Organization, Shunan, Japan
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17
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Chen SH, Wang PY, Lee MC, Wu JL, Chu YJ, Liu HM, Chen HS, Tseng WC. Point-of-Care Ultrasound Assists in Diagnosis of Necrotizing Enterocolitis in a Newborn. Indian J Pediatr 2024; 91:84-85. [PMID: 37209234 DOI: 10.1007/s12098-023-04624-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/13/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Szu-Han Chen
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Po-Yuan Wang
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Meng-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jhong-Lin Wu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Ju Chu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Ming Liu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ho-Sheng Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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18
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Duan XH, Duan Q, Liu JP, Le ZB, Xiao JQ, Ye R, Fang CF, Liu FE. Hepatic portal venous gas complication associated with the thoracic endovascular aortic repair for aortic dissection: a case report and literature review. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2023; 13:372-375. [PMID: 38205068 PMCID: PMC10774620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/29/2023] [Indexed: 01/12/2024]
Abstract
Aortic dissection (AD) is a serious disease with a higher mortality. The thoracic endovascular aortic repair (TEVAR) is a first line regimen for aortic dissection. Hepatic portal venous gas (HPVG) is a rare disease, and its definite mechanism is unknown. This is a rare association between the aortic and HPVG. In the present report, we present a case of thoracic aortic dissection, which was the type of Standford B by the computer tomography (CT) angiography, which implicated acute abdominal pain and abdominal distention after TEVAR and immediate abdominal CT shown hepatic portal venous gas (HPVG). The patient, who was treated with conservative treatment of gastrointestinal decompressing, fluid resuscitation, electrolyte replacement, anti-infection, anti-inflammation and anticoagulation, was recovered and discharged without abnormalities. This patient has been followed up for 5 years and has not experienced any physical discomfort related to HPVG. This is the first report that the aortic dissection patient implication with HPVG after thoracic endovascular aortic repair.
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Affiliation(s)
- Xun-Hong Duan
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Qing Duan
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Jian-Ping Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Zhi-Biao Le
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Jun-Qi Xiao
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Rong Ye
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Cui-Fu Fang
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Feng-En Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
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19
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Arico FM, Buemi F, Pitrone P, Giardina C, Trimarchi R, Borruto F, Doria S, Turiaco C, Caloggero S. Hepatic Portal Venous Gas (HPVG) after Ingestion of Chlorine Bleach: A Transient Phenomenon. Diagnostics (Basel) 2023; 13:3615. [PMID: 38132200 PMCID: PMC10742429 DOI: 10.3390/diagnostics13243615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
We present a case involving a 32-year-old man who ingested chlorine bleach with self-defeating intent. The ingestion of bleach can lead to a wide range of consequences, from mild mucosal burns to severe complications, rarely resulting in death. This case highlights the association between chlorine bleach ingestion and the development of hepatic portal venous gas (HPVG), a radiological finding traditionally thought to carry poor prognoses. The HPVG in this case resolved spontaneously within 24 h with conservative management, indicating its transient nature. The exact pathophysiological mechanisms responsible for HPVG after the ingestion of toxic substances .remain only partially understood. One hypothesis suggests that extensive damage to the gastrointestinal wall caused by caustic agent may allow enteric gas to enter the portal system. While HPVG after toxic ingestion is often transient, its consequences and potential risks should be carefully considered. Hyperbaric oxygen therapy is suggested in cases with neurological symptoms. In conclusion, HPVG is not a specific disease but rather a manifestation of various underlying factors, and its development in the context of chlorine bleach ingestion represents an additional insight to its understanding. It can be associated with severe medical conditions, but it is also found in less severe cases that can be managed conservatively.
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Affiliation(s)
- Francesco M. Arico
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | - Francesco Buemi
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | - Pietro Pitrone
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | | | - Renato Trimarchi
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Department of Radiology, ASST Bergamo Ovest, Ospedale Treviglio-Caravaggio, 24047 Treviglio, BG, Italy
| | - Flavia Borruto
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | - Sarah Doria
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | - Cristina Turiaco
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
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20
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Erdem S, Patel SV, Patel D, Patel S, Patel S, Chaudhary AJ. Understanding the Nuances of Hepatic Portal Venous Gas in Pneumatosis Intestinalis: An Indication of Bowel Ischemia? Cureus 2023; 15:e45330. [PMID: 37849594 PMCID: PMC10577153 DOI: 10.7759/cureus.45330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Pneumatosis intestinalis (PI) is a relatively rare gastrointestinal finding that has a wide variety of causes - ranging from benign to life-threatening. It is described as the pathological presence of gas within the bowel wall with multiple hypotheses emerging as to the likely mechanism. An important indicator of a life-threatening source of PI is the presence of gas within the hepatic portal vein, referred to as hepatic portal venous gas (HPVG). While non-specific for isolated PI, HPVG has been reported in PI patients to be associated with bowel ischemia and is thereby considered an indication for emergent management. Herein we report a case involving an atypical presentation of altered mental status in which the patient was found to have PI with contemporaneous HPVG. These findings have been reported to have a high mortality rate. Our patient rapidly deteriorated during their hospital course, expiring shortly after being deemed a poor surgical candidate due to their severe co-morbidity burden. Through this case, we review evidence supporting the management of patients with PI and concurrent HPVG from an extensive review of available literature. While PI is a non-specific finding and commonly a source of diagnostic confusion, a better understanding of its natural course and potentially unorthodox sequela may afford more directed and crucial care for critically ill patients, in which time is often a precious commodity.
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Affiliation(s)
- Saliha Erdem
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Suraj V Patel
- Internal Medicine, Ross University School of Medicine, Miramar, USA
| | - Dhruvil Patel
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Shivam Patel
- Biomedical Sciences, University of South Florida, Tampa, USA
| | - Shlok Patel
- Pharmaceutical Science, University of Michigan, Ann Arbor, USA
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21
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Hiroshi I, Nobutake S. Aspirin-Induced Small-Bowel Injury Presenting Portal Venous Gas. J Acute Med 2023; 13:129-133. [PMID: 37841821 PMCID: PMC10568637 DOI: 10.6705/j.jacme.202309_13(3).0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/20/2022] [Accepted: 02/15/2023] [Indexed: 10/17/2023]
Abstract
Aspirin is well known to damage small intestinal mucosa; however, little is known about the extra-intestinal manifestations of this aspirin-induced small-bowel injury. Herein, we report a case of aspirin-induced small-bowel injury in an 84-year-old Japanese man who presented with portal venous gas. Six weeks after the aspirin was stopped, his abdominal pain gradually resolved. Various intestinal disorders can manifest portal venous gas, and understanding the pathophysiology in such situations can help physicians to avoid anchoring bias in diagnosis.
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Affiliation(s)
- Ito Hiroshi
- University of Tsukuba HospitalDivision of Hospital MedicineIbarakiJapan
| | - Shimojo Nobutake
- University of Tsukuba HospitalDivision of Hospital MedicineIbarakiJapan
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22
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Machado M, Fernandes C, Cotter J. Pneumatosis Intestinalis and Aeroportia: A Case Report. Cureus 2023; 15:e45242. [PMID: 37842461 PMCID: PMC10576592 DOI: 10.7759/cureus.45242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
The presence of pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) is associated with severe diseases. A 71-year-old man was admitted to the emergency department with complaints of severe and persistent nausea, vomiting, and diffuse abdominal pain that had been present for one week. An abdominal computed tomography (CT) showed aeroportia and PI, suggesting intestinal ischemia. Despite refusing an emergent exploratory laparotomy, the patient received medical treatment. However, due to the advanced stage of the condition, the medical treatment was ineffective, and the patient died a few hours later.
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Affiliation(s)
- Marcia Machado
- Internal Medicine, Hospital da Senhora da Oliveira, Guimarães, PRT
| | - Carlos Fernandes
- Internal Medicine, Hospital da Senhora da Oliveira, Guimarães, PRT
| | - Jorge Cotter
- Internal Medicine, Hospital da Senhora da Oliveira, Guimarães, PRT
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23
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田 慈, 白 颐, 马 青, 葛 洪. [Clinical characteristics of 7 cases of hepatic portal venous gas]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2023; 55:743-747. [PMID: 37534661 PMCID: PMC10398756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Indexed: 08/04/2023]
Abstract
OBJECTIVE To summarize and analyze the clinical characteristics of patients diagnosed with hepatic portal venous gas (HPVG). METHODS This was a single center retrospective observational study. All of the patients were diagnosed with HPVG. The patients were admitted to Peking University Third Hospital from January 2017 to January 2021. Demographic characteristics, clinical manifestations, laboratory tests, abdominal imaging, treatment of the primary disease, and clinical outcomes of the patients were collected via electronic medical records. The study was approved by institutional review board and the information of all the patients was kept de-identified. RESULTS A total of seven cases were included in the study. The median age of the patients was 67 (63, 81) years. Six of the patients were male. The seven patients all presented with sudden onset of severe abdominal pain, which was the most common symptom. Six patients developed septic shock after admission. The signs of HPVG were detected by CT scans in all the patients, showing gas embolization. It might also be found as unique "aquarium sign" in abdominal ultrosonography. Four cases were caused by intestinal lesions, including acute volvulus, intestinal obstruction, and rectal abscess. Two were caused by ischemic bowel disease and the other one was caused by severe acute pancreatitis. The gas accumulation could disappear after effective anti-shock therapy and surgery (Cases 1, 2, and 6). Two patients had good postoperative outcomes, and one patient was discharged after non-surgical treatment. However, the prognosis was poor in the patients with intestinal ischemia necrosis accompanied by shock and multiple organ dysfunction (Cases 3, 4, 5, and 7 all died). CONCLUSION The HPVG patients generally have acute abdominal pain and show up at Emergency Department. The prognosis depends on the potential cause of HPVG. The mechanism and clinical management for the appearance of gas in the portal vein is not well understood. Patients complicated with shock, ascites, and peritonitis may have intestinal necrosis, which indicates surgical intervention and higher mortality. CT is the preferred diagnostic method in standard clinical practice. Physicians need to have a comprehensive understanding of the proactive diagnostic strategy, and active treatment for the primary disease.
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Affiliation(s)
- 慈 田
- />北京大学第三医院急诊科，北京 100191Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 颐 白
- />北京大学第三医院急诊科，北京 100191Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 青变 马
- />北京大学第三医院急诊科，北京 100191Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 洪霞 葛
- />北京大学第三医院急诊科，北京 100191Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
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24
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Mehl L, Schmidt C, Weidner U, Lock G. Sonographically Detected Hepatic Portal Venous Gas - Prevalence, Causes, and Clinical Implications. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:408-413. [PMID: 35483869 DOI: 10.1055/a-1797-9986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Hepatic portal venous gas (HPVG) is a rare clinical finding, often caused by a severe underlying disease. In the literature as well as in clinical practice, HPVG is considered "signum malum" with a poor prognosis and bowel ischemia as the most common cause. Most studies are based on the results of computed tomography (CT) examinations. The aim of this retrospective study is to report on the prevalence, causes, and clinical course of HPVG in a monocentric cohort of abdominal ultrasound (US) investigations. MATERIALS AND METHODS The US database of an academic teaching hospital was searched with specific keywords (timespan 01/2000 to 12/2020). Reports, pictures, and clinical data of all cases with HPVG were re-evaluated. RESULTS Out of 134 804 US examinations, 8 HPVG cases were identified. There was a wide variety of underlying diseases, with mesenteric ischemia being seen in only 2 cases. 5 patients were discharged in stable condition, with 4 of them having undergone surgical treatment. 2 patients who had rejected further measures died, and one was lost to follow-up. DISCUSSION HPVG is a rare phenomenon in clinical US. However, ultrasonographic prevalence is comparable to the prevalence in CT studies. Underlying diseases are mostly severe, and in nearly all cases an underlying cause can be found by thorough investigation. In some cases, US may even be superior to CT scans for the detection of HPVG. Despite its rarity, every sonographer should know the typical sonographic presentation of HPVG, and appropriate images should be included in US teaching modules.
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Affiliation(s)
- Lisa Mehl
- Internal Medicine, Albertinen Hospital, Hamburg, Germany
| | | | - Ulrike Weidner
- Institute for Radiology, Albertinen Hospital, Hamburg, Germany
| | - Guntram Lock
- Internal Medicine, Albertinen Hospital, Hamburg, Germany
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25
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Zhang Q, Meng H, Chen Y, Meng F. Bezoar as a cause of portal vein pneumatosis: a case report. J Int Med Res 2023; 51:3000605231180540. [PMID: 37377054 PMCID: PMC10328050 DOI: 10.1177/03000605231180540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Pneumatosis of the portal vein is considered a rare imaging sign rather than a disease. It usually occurs in patients with digestive tract diseases such as intestinal obstructive diseases, mesenteric vascular diseases, closed abdominal trauma, and liver transplantation. Because of its high mortality rate, it is also termed the "sign of death." Hawthorn contains tannic acid, and seafood is rich in calcium, iron, carbon, iodine, and other minerals and proteins. Thus, consuming both hawthorn and seafood together can result in the formation of an indigestible complex in the body, acting as the main pathogenic factor in patients with intestinal obstruction. We herein describe a patient with duodenal obstruction caused by hawthorn who developed the hepatic portal venous gas sign and was cured by nonsurgical treatment.
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Affiliation(s)
- Qing Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
| | - Heyu Meng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
| | - Yanqiu Chen
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
| | - Fanbo Meng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
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Iskander OA. Unraveling the Mystery of Hepatic Portal Vein Gas: Exploring Its Benign Nature and Surgical Implications. Cureus 2023; 15:e41231. [PMID: 37529512 PMCID: PMC10387453 DOI: 10.7759/cureus.41231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Hepatic portal venous gas (HPVG) is an infrequent yet potentially life-threatening condition that necessitates prompt diagnosis and effective management. This study presents the clinical scenario of an 88-year-old known diabetic patient, with chronic kidney disease (CKD), stroke, and hypertension, who was brought to the emergency department with symptoms of vomiting, constipation, and abdominal pain. Upon conducting a computed tomography (CT) scan of the abdomen, dilatation of the small bowel and pneumatosis intestinalis in the right abdomen, accompanied by the presence of air within the portal vein, were identified. Subsequently, an emergency laparotomy was performed, which revealed no evidence of ischemia, and the patient was treated with IV antibiotics. This case highlights the significance of adopting a multidisciplinary approach and timely interventions in the management of HPVG. The successful resolution of this complex case underscores the importance of prompt diagnosis, appropriate resuscitation, and surgical intervention, all of which play pivotal roles in enhancing patient outcomes.
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Higashijima U, Sekino M, Iwasaki N, Araki H, Motokawa T, Inoue Y, Taniguchi Y, Sato S, Miyazaki Y, Hara T. Acute mesenteric ischemia diagnosed using the aquarium sign: A case report. Medicine (Baltimore) 2023; 102:e33735. [PMID: 37171317 PMCID: PMC10174418 DOI: 10.1097/md.0000000000033735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
RATIONALE The diagnosis of mesenteric ischemia in critically ill patients remains challenging; however, the aquarium sign, comprising a large number of bubble images in the right cardiac chambers on echocardiography, may be used as a point-of-care ultrasound finding to diagnose acute mesenteric ischemia (AMI). PATIENT CONCERNS A 65-year-old woman diagnosed with lymphoma was urgently admitted to the intensive care unit with suspected tumor lysis syndrome. High-dose vasopressor and inotropic agents were required to manage the patient's shock with marked lactic acidosis and peripheral hypoperfusion with mottled skin, and multidisciplinary treatment was initiated. By day 6, the lactate levels normalized and there were no abnormal abdominal findings. An echocardiogram was performed to examine the mass lesion associated with lymphoma in the right atrium and evaluate the hemodynamics; it revealed an "aquarium sign." Similar findings were found in the inferior vena cava and portal vein. DIAGNOSES Contrast-enhanced computed tomography of the abdomen revealed hepatic portal vein gas, poor contrast of the colon wall, and intramural emphysema, and a diagnosis of AMI was made. Lower gastrointestinal endoscopy showed necrosis of the colon. INTERVENTIONS The patient underwent urgent subtotal colorectal resection. OUTCOMES Although a tracheostomy was required, the patient's general condition improved after surgery, and she was discharged to the ward without mechanical ventilatory support in the intensive care unit on Day 19. LESSONS In patients with risk factors for AMI, repeated evaluation for the presence of aquarium signs by echocardiography may be warranted, even if there are no abdominal findings or abnormalities in biomarkers, such as lactate levels and trends. When the aquarium sign is found, AMI should be aggressively suspected, and a definitive diagnosis should be made to initiate early therapeutic intervention.
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Affiliation(s)
- Ushio Higashijima
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
| | - Motohiro Sekino
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
| | - Naoya Iwasaki
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
| | - Hiroshi Araki
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
| | - Tetsufumi Motokawa
- Department of Cardiovascular Medicine, Nagasaki University Hospital, Sakamoto, Nagasaki, Japan
| | - Yusuke Inoue
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
| | - Yasuhiro Taniguchi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
| | - Shinya Sato
- Department of Hematology, Nagasaki University Hospital, Sakamoto, Nagasaki, Japan
| | - Yasushi Miyazaki
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Sakamoto, Nagasaki, Japan
| | - Tetsuya Hara
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
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Shao L, Li B, Sun Y, Hu H, Zhang Y, Xiang J, Chen H. Small bowel necrosis after esophagectomy. Thorac Cancer 2023; 14:848-852. [PMID: 36734100 PMCID: PMC10040276 DOI: 10.1111/1759-7714.14817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The study aimed to fully understand small bowel necrosis, a rare but fatal complication after esophagectomy. METHODS Patients who underwent esophagectomy for esophageal cancer at the Fudan University Shanghai Cancer Center from January 2013 to December 2021 were retrospectively reviewed. Clinical information on the demographics, presenting features, and outcomes of the cases were collected. RESULTS Of the 6607 patients during the study period, 11 (0.2%) underwent reoperation due to bowel necrosis, including nine males (81.8%) and two females (18.2%). Among them, eight cases (72.7%) had hypertension and seven (63.6%) suffered from lower thoracic esophageal cancer. Eight (72.7%) and three (27.3%) patients underwent the Ivor-Lewis and McKewon procedures, respectively. Jejunostomy was performed in nine patients (81.8%). The first signs of bowel necrosis appeared within 5 days after esophagectomy. Abdominal distension and deteriorating renal function were observed in seven patients (63.6%). There was no evidence of mesenteric vascular occlusion in any of the 11 cases, except for the hepatic portal venous gas found in seven patients on the computed tomography (CT) scan. Eight (72.7%) of the 11 patients underwent reoperation within 24 h due to the onset of the first symptoms. Eight (72.7%) had ileal necrosis, and three (27.3%) died. CONCLUSION Close attention should be paid to patients with abdominal distension, renal function damage, and portal hepatic venous gas after esophagectomy. These patients may suffer from small bowel necrosis, which may result in rapid disease progression. Exploratory laparotomy and bowel resection are effective treatments for such patients.
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Affiliation(s)
- Longlong Shao
- Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bin Li
- Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yihua Sun
- Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong Hu
- Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yawei Zhang
- Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaqing Xiang
- Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiquan Chen
- Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Air Where? An Ominous Finding on Point-of-Care Ultrasound Scanning. Chest 2023; 163:e97-e99. [PMID: 36759125 DOI: 10.1016/j.chest.2022.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/11/2022] [Accepted: 02/17/2022] [Indexed: 02/10/2023] Open
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30
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Shi L, Wang L, He M, Zhang Z. Severe acute pancreatitis with hepatic portal venous gas: A classic case report. Asian J Surg 2023:S1015-9584(22)01739-0. [PMID: 36621427 DOI: 10.1016/j.asjsur.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/08/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Lvyuan Shi
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, province, China
| | - Lietao Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, province, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, province, China.
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, province, China.
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Priyadarshi A, Rogerson S, Cruzado R, Crow A, Hinder M, Popat H, Soundappan SSV, Badawi N, Tracy M. Neonatologist-performed point-of-care abdominal ultrasound: What have we learned so far? Front Pediatr 2023; 11:1173311. [PMID: 37187587 PMCID: PMC10175674 DOI: 10.3389/fped.2023.1173311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
This review describes the sonographic appearances of the neonatal bowel in Necrotising enterocolitis. It compares these findings to those seen in midgut-Volvulus, obstructive intestinal conditions such as milk-curd obstruction, and slow gut motility in preterm infants on continuous positive airway pressure (CPAP)-CPAP belly syndrome. Point-of-care bowel ultrasound is also helpful in ruling out severe and active intestinal conditions, reassuring clinicians when the diagnosis is unclear in a non-specific clinical presentation where NEC cannot be excluded. As NEC is a severe disease, it is often over-diagnosed, mainly due to a lack of reliable biomarkers and clinical presentation similar to sepsis in neonates. Thus, the assessment of the bowel in real-time would allow clinicians to determine the timing of re-initiation of feeds and would also be reassuring based on specific typical bowel characteristics visualised on the ultrasound.
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Affiliation(s)
- Archana Priyadarshi
- Westmead Hospital Neonatal Intensive Care Unit, Sydney, NSW, Australia
- Grace Centre for Newborn Intensive Care at The Children`s Hospital Westmead, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
- Correspondence: Archana Priyadarshi
| | - Sheryl Rogerson
- The Royal Women's Hospital Neonatal Intensive Care Unit, Melbourne, VIC, Australia
| | - Rommel Cruzado
- Department of Radiology, The Children's Hospital Westmead, NSW, Australia
| | - Amanda Crow
- Department of Radiology, The Children's Hospital Westmead, NSW, Australia
| | - Murray Hinder
- Westmead Hospital Neonatal Intensive Care Unit, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Himanshu Popat
- Grace Centre for Newborn Intensive Care at The Children`s Hospital Westmead, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Soundappan S. V. Soundappan
- The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, The Children's Hospital Westmead, NSW, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Intensive Care at The Children`s Hospital Westmead, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Mark Tracy
- Westmead Hospital Neonatal Intensive Care Unit, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
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Transient portal venous gas in upper gastrointestinal bleeding: A case report. Radiol Case Rep 2022; 17:4260-4263. [PMID: 36120516 PMCID: PMC9474283 DOI: 10.1016/j.radcr.2022.08.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 12/02/2022] Open
Abstract
Portal venous gas (PVG) or hepatic portal venous gas (HPVG) is the accumulation of gas in the portal vein and its branches. HPVG may be considered as a nonspecific sign of a significant abdominal disease, ranging from potentially lethal diseases to benign conditions. Computed tomography (CT) can detect both the presence of gas and the underlying pathology. I report a 60-year-old male who presented to the emergency department with upper gastrointestinal bleeding and a high lactate level in the blood test. Because of the unknown etiology for the elevated lactate, a CT scan of the abdomen was taken, which showed that he developed intra-and extra-hepatic portal venous gas as well as in the portomesentric-portosystemic collaterals without any signs of mesenteric ischemia. The patient was treated conservatively and the HPVG completely resolved after a few days. Overall, physicians must be aware that prognosis is related to the pathology itself and is not influenced by the presence of PVG. HPVG can be caused by several benign conditions that do not necessarily require urgent exploratory laparotomy.
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Furtado T, Domingues P, Piedade A, Parreira L, Natário A. A Rare and Severe Cause of Abdominal Pain in a Hemodialysis Patient. Cureus 2022; 14:e30800. [DOI: 10.7759/cureus.30800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/07/2022] Open
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34
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Muacevic A, Adler JR. A Case Report on Hepatic Portal Venous Gas (HPVG). Cureus 2022; 14:e30689. [PMID: 36320790 PMCID: PMC9597268 DOI: 10.7759/cureus.30689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Hepatic Portal Venous Gas (HPVG) is the abnormal presence of gas in the portal venous system. It is associated with life-threatening conditions and is a sinister radiological sign. This case report aims to evaluate the significance of HPVG as a radiological sign. Our case involves a 49-year-old man who was admitted to the hospital following a one-day history of severe epigastric pain and haematemesis. Investigations showed extensive HPVG, gastric pneumatosis, a large retroperitoneal haematoma, and an obstructive lesion between the first and second part of the duodenum. Our patient was managed conservatively in the High Dependency Unit (HDU). A repeat Computerised Tomography (CT) scan showed successful resolution of the HPVG and gastric pneumatosis without any invasive intervention.
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35
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Hu SF, Liu HB, Hao YY. Portal vein gas combined with pneumatosis intestinalis and emphysematous cystitis: A case report and literature review. World J Clin Cases 2022; 10:8945-8953. [PMID: 36157643 PMCID: PMC9477024 DOI: 10.12998/wjcc.v10.i25.8945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/21/2022] [Accepted: 07/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Portal venous gas (PVG) is a rare clinical condition usually indicative of severe disorders, including necrotizing enterocolitis, bowel ischemia, or bowel wall rupture/infarction. Pneumatosis intestinalis (PI) is a rare illness characterized by an infiltration of gas into the intestinal wall. Emphysematous cystitis (EC) is relatively rare and characterized by intramural and/or intraluminal bladder gas best depicted by cross-sectional imaging. Our study reports a rare case coexistence of PVG presenting with PI and EC.
CASE SUMMARY An 86-year-old woman was admitted to the emergency room due to the progressive aggravation of pain because of abdominal fullness and distention, complicated with vomiting and stopping defecation for 4 d. The abdominal computed tomography (CT) plain scan indicated intestinal obstruction with ischemia changes, gas in the portal vein, left renal artery, superior mesenteric artery, superior mesenteric vein, some branch vessels, and bladder pneumatosis with air-fluid levels. Emergency surgery was conducted on the patient. Ischemic necrosis was found in the small intestine approximately 110 cm below the Treitz ligament and in the ileocecal junction and ascending colon canals. This included excision of the necrotic small intestine and right colon, fistulation of the proximal small intestine, and distal closure of the transverse colon. Subsequently, the patient displayed postoperative short bowel syndrome but had a good recovery. She received intravenous fluid infusion and enteral nutrition maintenance every other day after discharge from the community hospital.
CONCLUSION Emergency surgery should be performed when CT shows signs of PVG with PI and EC along with a clinical situation strongly suggestive of bowel ischemia.
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Affiliation(s)
- Shi-Fu Hu
- Department of General Surgery, Tianjin Xiqing Hospital, Tianjin 300100, China
| | - Han-Bo Liu
- Department of General Surgery, Tianjin Xiqing Hospital, Tianjin 300100, China
| | - Yuan-Yuan Hao
- Department of Geriatrics, Tianjin Xiqing Hospital, Tianjin 300100, China
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36
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Fukui S, Ito H, Moritani I, Shiraki K. Massive hepatic portal venous gas caused by gastric emphysema. BMJ Case Rep 2022; 15:e250309. [PMID: 35817491 PMCID: PMC9274537 DOI: 10.1136/bcr-2022-250309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shunsuke Fukui
- Department of Gastroenterology, Mie Prefectural General Medical Center, Yokkaichi, Mie, Japan
| | - Hideki Ito
- Department of Surgery, Mie Prefectural General Medical Center, Yokkaichi, Mie, Japan
| | - Isao Moritani
- Department of Gastroenterology, Mie Prefectural General Medical Center, Yokkaichi, Mie, Japan
| | - Katsuya Shiraki
- Department of Gastroenterology, Mie Prefectural General Medical Center, Yokkaichi, Mie, Japan
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Jarry S, Calderone A, Dion D, Bouchard D, Couture ÉJ, Denault A. Acute Cardiointestinal Syndrome Resulting From Postoperative Acute Biventricular Heart Failure. J Cardiothorac Vasc Anesth 2022; 36:2220-2227. [PMID: 35331631 DOI: 10.1053/j.jvca.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/08/2022] [Indexed: 01/16/2023]
Affiliation(s)
- Stéphanie Jarry
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Alexander Calderone
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Daniel Dion
- Department of Pathology and Cell Biology, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - Denis Bouchard
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Étienne J Couture
- Department of Anesthesiology and Department of Medicine, Division of Intensive Care Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada
| | - André Denault
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada; Division of Critical Care, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
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Epin A, Passot G, Christou N, Monneuse O, Mabrut JY, Ferrero PA, Caudron S, Pezet D, Magnin B, Grange R, Lambert C, Williet N, Flaris AN, Le Roy B. Gastric Pneumatosis with Portal Venous Gas can be Treated Non-operatively: A Retrospective Multi-institutional Study. World J Surg 2022; 46:784-790. [DOI: 10.1007/s00268-021-06433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/27/2022]
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Benson CB, Frates MC. Color Duplex Scanning of the Hepatoportal Circulation. NONINVASIVE VASCULAR DIAGNOSIS 2022:933-960. [DOI: 10.1007/978-3-030-60626-8_48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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40
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Ch R, Vaithiyam VS, Manchanda S, Barman Roy D, Kumar S, Ray A, Vikram N. A 23-Year-Old Woman With a Rare Presentation of Systemic Lupus Erythematosus and Its Complication. Chest 2021; 160:e661-e664. [PMID: 34872682 DOI: 10.1016/j.chest.2021.02.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/19/2021] [Accepted: 02/06/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Rahul Ch
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Smita Manchanda
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Debarchan Barman Roy
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanchit Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Naval Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Xu L, Wang Y, Li W. A case report of fatal hepatic portal venous gas after transcatheter arterial chemoembolization in a patient with hepatocellular carcinoma. Transl Cancer Res 2021; 10:5437-5442. [PMID: 35116389 PMCID: PMC8798820 DOI: 10.21037/tcr-21-1721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/04/2021] [Indexed: 11/21/2022]
Abstract
Hepatic portal venous gas (HPVG) refers to the imaging signs formed by the abnormal accumulation of abnormal gas in the portal veins and the branches of the inner veins of the liver due to various reasons, and is usually associated with poor prognosis. HPVG is mostly caused by abdominal diseases. Herein, we reported a patient with hepatocellular carcinoma developed HPVG following transcatheter arterial chemoembolization (TACE). This patient was identified as Barcelona Clinic Liver Cancer (BCLC) stage B, and treated by five times of TACE. Gelfoam sponge was used as embolic agent in the first and last TACE treatment. After the first TACE, pneumonia occurred in the right lung, and pneumorachis with iodine oil deposition occurred in the tumor lesion in the right lobe of the liver, which was considered as hepatic abscess. After three more TACE, enhanced MRI showed significant necrosis and reduction of the lesions. After the fifth TACE, the enhancing computed tomography (CT) showed a large amount of gas in the lesions and in the portal veins, which was considered as HPVG. Although after active treatment, the patient died soon. To our knowledge, this is the first case report of a patient with hepatocellular carcinoma developed HPVG following TACE with gelfoam sponge as embolic agent.
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Affiliation(s)
- Lichao Xu
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ying Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wentao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
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Yuan K, Chen QQ, Zhu YL, Luo F. Hepatic portal venous gas without definite clinical manifestations of necrotizing enterocolitis in a 3-day-old full-term neonate: A case report. World J Clin Cases 2021; 9:9269-9275. [PMID: 34786413 PMCID: PMC8567523 DOI: 10.12998/wjcc.v9.i30.9269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/20/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neonatal hepatic portal venous gas (HPVG) is associated with a high risk of necrotizing enterocolitis (NEC) and was previously believed to be associated with an increased risk of surgery.
CASE SUMMARY A 3-day-old full-term male infant was admitted to the pediatrics department after presenting with “low blood glucose for 10 min”. Hypoglycemia was corrected by intravenous glucose administration and oral breast milk. On the 3rd d after admission, an ultrasound examination showed gas accumulation in the hepatic portal vein; this increased on the next day. Abdominal vertical radiograph showed intestinal pneumatosis. Routine blood examination showed that the total number of white blood cells was normal, but neutrophilia was related to age. There was a significant increase in C-reactive protein (CRP). The child was diagnosed with neonatal NEC (early-stage). With nil per os, rehydration, parenteral nutritional support, and anti-infection treatment with no sodium, his hepatic portal vein pneumatosis resolved. In addition, routine blood examination and CRP examination showed significant improvement and his symptoms resolved. The patient was given timely refeeding and gradually transitioned to full milk feeding and was subsequently discharged. Follow-up examination after discharge showed that the general condition of the patient was stable.
CONCLUSION The presence of HPVG in neonates indicates early NEC. Early active anti-infective treatment is effective in treating NEC, minimizes the risk of severe NEC, and reduces the need for surgery. The findings of this study imply that early examination of the liver by ultrasound in a sick neonate can help with the early diagnosis of conditions such as NEC.
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Affiliation(s)
- Ke Yuan
- Department of Pediatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Qing-Qing Chen
- Department of Pediatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Yi-Lin Zhu
- Department of Pediatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Fang Luo
- Department of Pediatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Takiguchi T, Arai M, Kim S, Ishii H, Ogasawara T, Shigeta K, Mizobuchi T, Yokobori S. Nonocclusive mesenteric ischemia associated with a hyperosmolar hyperglycemic state: Hepatic portal venous gas as an indicator of mesenteric ischemia. Acute Med Surg 2021; 8:e673. [PMID: 34221411 PMCID: PMC8243755 DOI: 10.1002/ams2.673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/12/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background The diagnosis of nonocclusive mesenteric ischemia (NOMI) is always challenging in critically ill patients. Herein, we aimed to report a case of NOMI associated with a hyperosmolar hyperglycemic state (HHS). A small amount of hepatic portal venous gas (HPVG) triggered the diagnosis of NOMI. Case Presentation A 77‐year‐old man was transferred due to shock and disorder of consciousness. He was diagnosed with an HHS. We suspected intestinal ischemia due to a small amount of HPVG revealed by computed tomography (CT). Peritoneal signs were revealed after treatment for the HHS. Computed tomography was carried out again 5 h after admission, which showed a large amount of HPVG, remarkable bowel dilatation, and pneumatosis intestinalis. We performed an emergency laparotomy and resected the small bowel necrosis resulting from NOMI. Conclusion An HHS can cause NOMI, and the presence of HPVG on CT is an important finding that suggests mesenteric ischemia, even in small amounts.
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Affiliation(s)
- Toru Takiguchi
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Masatoku Arai
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Shiei Kim
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Hiromoto Ishii
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Tomoko Ogasawara
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Kenta Shigeta
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Taiki Mizobuchi
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
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Bitar ZI, Elhabibi ME, Maadarani OS, Albirami AK, Elzoueiry MM, Zaalouk TM. Hepatic portal vein gas detected by point of care ultrasound. Int J Surg Case Rep 2021; 83:105974. [PMID: 34022761 PMCID: PMC8164028 DOI: 10.1016/j.ijscr.2021.105974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Portal venous gas is a rare finding in adults and is typically associated with underlying intestinal ischemia. Portal venous gas can be detected by a bedside point of care ultrasound (POCUS) examination in adult patients in critical care units (CCU). Findings include echogenic bubbles flowing centrifugally throughout the portal venous system. Case presentation We present the case of a 73-year-old female with advanced ischemic cardiomyopathy and cardiorenal syndrome who was managed in the CCU. She developed vague abdominal pain and respiratory depression requiring intubation and dialysis during her course of treatment in the CCU. Her findings were consistent with portal venous gas upon POCUS, prompting computed tomography of her abdomen and surgical consultation. She was ultimately found to have nonobstructive mesenteric ischemia. Clinical discussion PVG is an ominous radiological sign and reflects intestinal ischemia in up to 72% of cases. Acute mesenteric ischemia of the small bowel could be due to occlusive or nonocclusive obstruction of the arterial blood supply or obstruction of venous outflow. Nonocclusive obstruction accounts for 5% to 15% of patients with acute mesenteric ischemia. Conclusion With the increasing use of POCUS, critical care physicians should be aware of findings consistent with portal venous gas as a bedside tool for directing the treating physician toward an ominous diagnosis in patients with shock.
Portal vein gas detected by point-of-care ultrasound in situations of unidentified shock indicates a high likelihood of underlying intestinal ischemia. Point-of-care ultrasound plays an important role in detecting the sources of surgical emergencies. Nonobstructive mesenteric ischemia can present with nonspecific symptoms in critically ill patients, leading to a delay in diagnosis.
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Affiliation(s)
| | | | - Ossama Sajeh Maadarani
- Critical Care Unit, Ahmadi Hospital, Kuwait Oil Company, PO BOx 46468, 64015, Fahahil, Kuwait.
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Cassese G, Maione F, Alagia M, Ambrosio L, Caruso E, Chini A, Cimmino C, Nasto RA, Pegoraro F, Giglio MC, De Palma GD. Portal venous gas after a failed endoscopic retrograde cholangiopancreatography attempt in a patient with a large hepatocellular carcinoma: A case report. Clin Case Rep 2021; 9:1339-1343. [PMID: 33768840 PMCID: PMC7981622 DOI: 10.1002/ccr3.3766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 12/07/2022] Open
Abstract
The cause of hepatic portal vein gas (HPVG) is variable. Good knowledge of the possible causes, combined with the clinical assessment of the patient and a good quality imaging, is required to correctly identify the underlying cause of HPVG and to best predict the prognosis.
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Affiliation(s)
- Gianluca Cassese
- Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NapoliItaly
| | - Francesco Maione
- Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NapoliItaly
| | - Mariantonietta Alagia
- Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NapoliItaly
| | - Luisa Ambrosio
- Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NapoliItaly
| | - Emanuele Caruso
- Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NapoliItaly
| | - Alessia Chini
- Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NapoliItaly
| | - Claudio Cimmino
- Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NapoliItaly
| | - Riccardo Aurelio Nasto
- Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NapoliItaly
| | - Francesca Pegoraro
- Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NapoliItaly
| | - Mariano Cesare Giglio
- Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NapoliItaly
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NapoliItaly
- Center of Excellence for Technical Innovation in Surgery of Naples“CEITC Unina”NapoliItaly
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Khashana A, Abdel-Wahab A, Khalil M, Omar H. Evaluation of cachectin level in preterm neonates as an indicator of necrotizing enterocolitis. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_166_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kogo H, Takasaki H, Sakata Y, Nakamura Y, Yoshida H. A case of hepatic portal venous gas that resolved with conservative treatment. Clin Case Rep 2021; 9:584-585. [PMID: 33489222 PMCID: PMC7813089 DOI: 10.1002/ccr3.3534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/27/2020] [Accepted: 10/21/2020] [Indexed: 12/02/2022] Open
Abstract
Hepatic portal venous gas (HPVG) is a potentially fatal condition. If vital signs are normal and laboratory data are not suggestive of any necrotic changes, a follow-up computed tomography after a conservative procedure can be performed at short intervals to conservatively monitor the patient.
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Affiliation(s)
- Hideki Kogo
- Department of SurgeryNippon Medical School Tama‐Nagayama HospitalTokyoJapan
| | | | | | | | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato‐Biliary‐Pancreatic SurgeryNippon Medical SchoolTokyoJapan
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Bao LX, Hu X, Guo WD. Hepatic portal venous gas after radical cholangiocarcinectomy. Quant Imaging Med Surg 2020; 10:2376-2378. [PMID: 33269235 DOI: 10.21037/qims-20-565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Le-Xin Bao
- Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao Hu
- Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei-Dong Guo
- Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
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Pediatric milk protein allergy causing hepatic portal venous gas: Case report. Radiol Case Rep 2020; 16:246-249. [PMID: 33304435 PMCID: PMC7708755 DOI: 10.1016/j.radcr.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/30/2022] Open
Abstract
Hepatic portal venous gas (HPVG) is a rare imaging finding in infants and usually indicative of a severe disease process such as necrotizing enterocolitis, bowel ischemia, or bowel wall rupture / infarction. The diagnosis of HPVG may have serious implications such as parenteral nutrition, antibiotics and even surgery. In this case, we present an 8-week-old male with a history of prematurity presenting with HPVG, later concluded to be caused by milk protein allergy. Milk protein allergy is a rare cause of HPVG, but it should be recognized due to its benignity and potential prevention of unnecessary testing and interventions.
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Spiller KT, Eisenberg BW. Extensive hepatic portal venous gas and gastric pneumatosis in a cat. Vet Med Sci 2020; 7:593-599. [PMID: 33222419 PMCID: PMC8025634 DOI: 10.1002/vms3.399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/30/2020] [Accepted: 10/25/2020] [Indexed: 01/05/2023] Open
Abstract
A 15-year-old female neutered Domestic Long Hair cat was presented for acute hematemesis. Initial diagnostic workup, including serum biochemistry panel, complete blood count and coagulation profile, was unremarkable. Abdominal ultrasound showed gastric mural thickening and non-obstructive gastric foreign material. Endoscopy was performed to remove the foreign matter and obtain biopsies. Significant abnormalities of the upper gastrointestinal (GI) tract were not noted endoscopically. Overnight, the patient required a packed red blood cell transfusion following two episodes of severe hematemesis, hypotension and collapse. Serial radiographs and ultrasound revealed hepatic portal venous gas (HPVG). Computed tomography (CT) scan confirmed massive gas accumulation within the liver and emphysematous gastritis. The patient became increasingly unstable and, given her rapid decline, humane euthanasia was elected. Gastric and duodenal histopathology showed inflammatory changes, spirochetosis and mucosal epithelial degeneration. HPVG is a rarely described finding and prognosis varies drastically depending on aetiology. To the best of our knowledge, this is the first description of portal vein gas documented on multiple imaging modalities, including CT, in a cat. The patient in this report had several potential risk factors including prior endoscopy, compromise of the intestinal barrier and evidence of gastric mural bacterial invasion.
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