Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2021; 9(30): 9269-9275
Published online Oct 26, 2021. doi: 10.12998/wjcc.v9.i30.9269
Hepatic portal venous gas without definite clinical manifestations of necrotizing enterocolitis in a 3-day-old full-term neonate: A case report
Ke Yuan, Qing-Qing Chen, Yi-Lin Zhu, Fang Luo
Ke Yuan, Qing-Qing Chen, Yi-Lin Zhu, Fang Luo, Department of Pediatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Yuan K and Luo F conceived and designed the study; Yuan K, Chen QQ, and Zhu YL provided clinical research; Yuan K wrote the paper; all authors reviewed and edited the manuscript, and read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient’s parents for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fang Luo, MD, Chief Doctor, Department of Pediatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. 6305005@zju.edu.cn
Received: May 28, 2021
Peer-review started: May 28, 2021
First decision: June 15, 2021
Revised: June 20, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: October 26, 2021
Processing time: 146 Days and 4.5 Hours
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.

Keywords: Hepatic portal venous gas; Neonates; Clinic; Ultrasound; Early diagnosis; Case report

Core Tip: This manuscript reports a case of acute hepatic portal venous gas in a full-term infant and the results of a clinical analysis and literature review of the case. The findings of the study show that liver ultrasound examination is important for the early diagnosis of neonatal necrotizing enterocolitis (NEC). Effective and timely treatment of NEC reduces the risk of severe NEC and surgery.