Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.8945
Peer-review started: January 25, 2022
First decision: May 9, 2022
Revised: May 21, 2022
Accepted: July 21, 2022
Article in press: July 21, 2022
Published online: September 6, 2022
Processing time: 213 Days and 0.2 Hours
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.
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.
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.
Core Tip: Portal venous gas (PVG) caused by intestinal necrosis is a severe condition requiring surgery. PVG with superior mesenteric vessel gas, pneumatosis intestinalis (PI), and emphysematous cystitis (EC) reflect different stages of the same pathophysiological disorder. The specificity of PVG, PI, and mesenteric vein gas to computed tomography diagnosis of acute intestinal ischemia is nearly 100%. The coexistence of PVG, PI, and mesenteric venous gas can be an important diagnostic marker for acute ischemic bowel disease. When intestinal ischemia or necrosis is suspected, active surgical exploration should be the first line of treatment. It is rare for PVG to be complicated with superior mesenteric vessels gas, PI, and EC.