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Kim HJ, Kim HK. Idiopathic Hepatic Portal Venous Gas in a Healthy Young Man. Int J Gen Med 2020; 13:687-692. [PMID: 33061536 PMCID: PMC7519867 DOI: 10.2147/ijgm.s276438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022] Open
Abstract
Background Hepatic portal venous gas (HPVG) is a pathological condition characterized by gas in the portal venous system and its branches. The clinical manifestations of HPVG range from benign to life-threatening conditions. Here, we present a rare case of HPVG accompanied by free air in a healthy young patient without any suspicious etiology. Case Presentation A 28-year-old man without any specific medical history complained of sudden-onset dyspnea. On admission, his vital signs were stable, and the laboratory tests and physical examinations were within normal range. A plain chest and abdominal film revealed subphrenic free air and HPVG. Contrast-enhanced computed tomography (CT) showed extensive portal venous gas throughout the liver; however, there were no abnormal findings indicative of the etiology. Considering the stable vital signs and the lack of physical findings suggesting a surgical acute abdomen, the patient was managed conservatively. On admission day 3, the subphrenic free air and HPVG shown in the initial study had almost resolved, with no new symptoms. He was discharged on the fourth day after admission without any complications. Esophagogastroduodenoscopy, colonoscopy, and colonography protocol CT scan showed no significant abnormalities. Conclusion This case suggests that idiopathic HPVG could appear in healthy patients complaining only of vague symptoms. Initial conservative management could be considered if HPVG does not result from a life-threatening condition that needs immediate management, and if the patient is stable.
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Affiliation(s)
- Hong Jun Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Hong-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Panico C, di Meo M, Tammaro N, Pirozzi REM, Cusati B. Porto-mesenteric venous gas as a sign of gastric mucosal damage remitted after surgery: a case report. Acta Radiol Open 2020; 9:2058460120911586. [PMID: 32284881 PMCID: PMC7137391 DOI: 10.1177/2058460120911586] [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: 08/05/2019] [Accepted: 02/17/2020] [Indexed: 11/15/2022] Open
Abstract
Porto-mesenteric venous gas (PMVG) is a severe sign of abdominal organs damage. Imaging diagnostic criteria allow the detection of PMVG and should be applied in the presence of severe symptoms and signs of abdominal organs damage. Our case had clinical signs of epigastric pain and abdominal tenderness and ultrasonography and computed tomography evidence of PMVG and gastric cancer. The subsequent surgery, without complications, induced PMVG to disappear and the patient to be dismissed from hospital.
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Affiliation(s)
- Camilla Panico
- Dipartimento di Scienze Biomediche Avanzate, Università di Napoli Federico II, Naples, Italy
- ASL Napoli 2 NORD, Santa Maria delle Grazie, Italy
- Camilla Panico, Università degli Studi di Napoli Federico II, via Pansini 5, Naples, 80131, Italy.
| | | | - Nicola Tammaro
- ASL Napoli 2 NORD, Santa Maria delle Grazie, Italy
- Dipartimento di Chirurgia Generale e Specialistica, Università di Napoli Federico II, Naples, Italy
| | - Raffaele EM Pirozzi
- ASL Napoli 2 NORD, Santa Maria delle Grazie, Italy
- Dipartimento di Chirurgia Generale e Specialistica, Università di Napoli “L. Vanvitelli,” Naples, Italy
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Murzi M, Gordillo J, Oblitas E, Soriano G, Pernas JC, Posso M, Garcia-Planella E. Spontaneous hepatic portal venous gas in a patient with ulcerative colitis. A case report and a review. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 43:22-25. [PMID: 31640909 DOI: 10.1016/j.gastrohep.2019.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/16/2019] [Accepted: 08/22/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Marianette Murzi
- Gastroenterology and Hepatology Unit. Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Jordi Gordillo
- Gastroenterology and Hepatology Unit. Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain.
| | - Elida Oblitas
- Gastroenterology and Hepatology Unit. Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - German Soriano
- Gastroenterology and Hepatology Unit. Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain; Centro de Investigaciones Biomédicas en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Carlos Pernas
- Radiology Department, Abdominal Section. Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Margarita Posso
- Service of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Esther Garcia-Planella
- Gastroenterology and Hepatology Unit. Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
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Muratsu A, Muroya T, Yui R, Nakamura F, Kishimoto M, Sakuramoto K, Kuwagata Y. Factors associated with bowel necrosis in patients with hepatic portal venous gas and pneumatosis intestinalis. Acute Med Surg 2019; 7:e432. [PMID: 31988756 PMCID: PMC6971442 DOI: 10.1002/ams2.432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/26/2019] [Indexed: 11/26/2022] Open
Abstract
Aim Historically, the presence of hepatic portal venous gas (HPVG) and pneumatosis intestinalis (PI) have been reported to be associated with bowel necrosis and fatal outcome. However, there are no criteria to judge whether bowel necrosis has occurred. We aimed to examine the factors associated with bowel necrosis in patients with HPVG and PI. Methods The study comprised 25 patients who were diagnosed as having HPVG and/or PI based on computed tomography (CT) findings in the Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital (Osaka, Japan) between April 2013 and August 2017. We compared various factors, including clinical history, severity of present illness, laboratory data, and CT findings, and examined whether they were related to bowel necrosis. Results Both Sequential Organ Failure Assessment scores and total bilirubin levels were significantly higher in the necrosis group than those in the non‐necrosis group (P = 0.03 and P = 0.02, respectively). The quantity of portal venous gas observed on computed tomography was associated with bowel necrosis in patients with HPVG. In contrast, the presence of air‐type PI, defined as PI with emphysema covering the total circumference of the intestine in the absence of wall edema, and the presence of free air were significantly higher in the non‐necrosis group (both P < 0.01). Conclusions This study showed that the quantity of HPVG was associated with bowel necrosis, whereas the presence of free air or air‐type PI was associated with non‐necrosis of the bowel.
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Affiliation(s)
- Arisa Muratsu
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Rintaro Yui
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
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5
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Chen H, Wu Q, Fang H, Liang B, Fang L. Intestinal necrosis cannot be neglected in a patient with hepatic portal vein gas combined with appendicitis: a rare case report and literature review. BMC Surg 2019; 19:17. [PMID: 30717721 PMCID: PMC6360744 DOI: 10.1186/s12893-019-0478-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/24/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hepatic portal vein gas (HPVG) is a rare acute abdomen, which is not an independent disease. Meanwhile, HPVG combined with appendicitis has been rarely reported. We found only a similar report by looking for literature, but no intestinal necrosis occurred. We report a patient with HPVG, appendicitis and intestinal necrosis was reported in the current study. The patient was given frequent monitoring and had been conducted operation in time. CASE PRESENTATION An 86-year-old female with appendicitis complicated by HPVG was reported in the present study. Abdominal examination revealed rebound tenderness at the McBurney's point. Moreover, abdominal computed tomography (CT) revealed gas in portal and mesenteric veins in addition to appendicitis. An emergency operation was planned on the appendix. However, the patient refused surgical treatment. Therefore, conservative treatment of antibiotics and frequent imaging observation was conducted for this patient. Although imaging results suggested disappeared gas in intra- and extra-hepatic portal veins, the small intestine was dilated, after conservative treatment of antibiotics. In addition, signs of diffused peritonitis could also be observed and an exploratory laparotomy was performed. Intra-operative findings had confirmed suppurated appendix, mesenteric ischemia and small intestinal necrosis. CONCLUSIONS Frequent monitoring benefits us in observing the progress of intestinal diseases. When there exist other possible causes of HPVG such as infection, it is not easy for us to ignore the possibility of intestinal necrosis.
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Affiliation(s)
- Haimin Chen
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Nanchang University, No. 1, mingde road, Nanchang, Jiang xi China
| | - Qingsong Wu
- Department of Hepatobiliary Surgery, Yuebei people‘s hospital, Shaoguan, Guangdong China
| | - Hongcai Fang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Jiujiang University, Jiujiang, Jiang xi China
| | - Bo Liang
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Nanchang University, No. 1, mingde road, Nanchang, Jiang xi China
| | - Lu Fang
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Nanchang University, No. 1, mingde road, Nanchang, Jiang xi China
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Zhang YB, Yuan YS, Li JG, Liu ZK, Chen LM, Ji ZW. Extensive gas embolism of portacaval system in a patient with blunt abdominal trauma. Shijie Huaren Xiaohua Zazhi 2015; 23:358-362. [DOI: 10.11569/wcjd.v23.i2.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Extensive portal vein and inferior vena cava gas embolism is the late presentation of hepatic portal venous gas (HPVG), and it is a rare clinical condition. This paper reports a case of extensive gas embolism of the portocaval system due to closed abdominal injury. A literature review was also performed to better understand the epidemiology, etiology, pathogenesis, diagnosis and treatment of HPVG.
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Naguib N, Mekhail P, Gupta V, Naguib N, Masoud A. Portal venous gas and pneumatosis intestinalis; radiologic signs with wide range of significance in surgery. JOURNAL OF SURGICAL EDUCATION 2012; 69:47-51. [PMID: 22208832 DOI: 10.1016/j.jsurg.2011.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 07/20/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND Portal vein gas (PVG) was described as an uncommon ominous radiologic sign usually harboring an intra-abdominal catastrophe. When accompanied by pneumatosis intestinalis (PI), it is more predictive of bowel ischemia. Since the wide use of computed tomography (CT), both signs could also be viewed as incidental findings during routine radiologic investigations. METHODS We present a series of 12 cases that showed either or both signs, collected in a district general hospital between 1991 and 2011. RESULTS The diagnoses in these cases varied between fatal bowel ischemia and the mere presence of radiologic signs in the absence of significant pathology. CONCLUSION PVG and PI are radiologic signs that can represent a wide range of pathology.
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Affiliation(s)
- Nader Naguib
- Department of Surgery, Prince Charles Hospital, Merthyr Tydfil, United Kingdom.
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8
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Answer. CAN J EMERG MED 2010. [DOI: 10.1017/s1481803500012823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abboud B, El Hachem J, Yazbeck T, Doumit C, Hechtman HB. Hepatic portal venous gas: Physiopathology, etiology, prognosis and treatment. World J Gastroenterol 2009; 15:3585-90. [PMID: 19653334 PMCID: PMC2721230 DOI: 10.3748/wjg.15.3585] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatic portal venous gas (HPVG), an ominous radiologic sign, is associated in some cases with a severe underlying abdominal disease requiring urgent operative intervention. HPVG has been reported with increasing frequency in medical literature and usually accompanies severe or lethal conditions. The diagnosis of HPVG is usually made by plain abdominal radiography, sonography, color Doppler flow imaging or computed tomography (CT) scan. Currently, the increased use of CT scan and ultrasound in the inpatient setting allows early and highly sensitive detection of such severe illnesses and also the recognition of an increasing number of benign and non-life threatening causes of HPVG. HPVG is not by itself a surgical indication and the treatment depends mainly on the underlying disease. The prognosis is related to the pathology itself and is not influenced by the presence of HPVG. Based on a review of the literature, we discuss in this paper the pathophysiology, risk factors, radiographic findings, management, and prognosis of pathologies associated with HPVG.
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10
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Chirica M, Scatton O. [Air in the portal venous system: radiologic differential diagnosis and etiology-specific treatment]. ACTA ACUST UNITED AC 2006; 143:141-7. [PMID: 16888598 DOI: 10.1016/s0021-7697(06)73641-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Portal venous air is a rare but potentially grave radiologic sign. The routine use of abdominal CT and ultrasound allows the detection of minimal amounts of portal air, often at an asymptomatic stage. The first diagnosis to consider by both frequency and gravity is intestinal necrosis which carries a 75% mortality. And yet there are also benign etiologies of portal venous air, usually asymptomatic, which do not require surgical intervention. The aim of this study is to describe the differential diagnosis of portal venous air and its clinical management.
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Affiliation(s)
- M Chirica
- Service de Chirurgie Digestive, Hôpital Cochin - Paris
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11
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Horowitz NS, Cohn DE, Herzog TJ, Mutch DG, Rader JS, Bhalla S, Gibb RK. The significance of pneumatosis intestinalis or bowel perforation in patients with gynecologic malignancies. Gynecol Oncol 2002; 86:79-84. [PMID: 12079304 DOI: 10.1006/gyno.2002.6728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The objectives of this study were to evaluate the clinical significance and outcome of pneumatosis intestinalis or bowel perforation in patients with gynecologic malignancies. METHODS A retrospective review of all gynecologic oncology patients at our institution from 1996 to the present was performed to identify computed tomography examinations showing pneumatosis, free air, or the presence of portal venous gas. Admission symptoms, laboratory testing, radiographic and operative findings, and overall survival were evaluated. At the discretion of the attending gynecologic oncologist, patients were managed either surgically or conservatively. Statistical analysis was performed with Fisher's exact test. RESULTS Twenty-eight patients met study criteria. Thirteen patients were excluded as a result of radiographic free air immediately following surgery, thus leaving 15 patients for analysis. Sixty percent (n = 9) of patients were managed surgically while 40% (n = 6) were managed conservatively. Pain and tenderness at presentation prompted surgical intervention in a statistically significant number of patients (P = 0.04). No other sign or symptom was significant. Of the 6 patients managed conservatively, 3 (50%) died within 1 week of diagnosis. Survival for the others was 2, 4, and 6 months. Of the 9 patients managed surgically 6 (67%) patients died, 4 within 2 weeks of surgery and the remainder at 2 and 12 months postoperatively. The 3 patients who survived all had surgical intervention and none had radiographic or pathologic evidence of cancer at the time of presentation (P = 0.01). Overall mortality at 6 months was 73% (11/15). Surgical management was associated with prolonged ICU care, mechanical ventilation, and sepsis. CONCLUSIONS Pneumatosis intestinalis and bowel perforation carry a grave prognosis for patients with gynecologic malignancies. These data suggest that patients explored for radiographic evidence of pneumatosis or perforation with preoperative evidence of active malignancy do not survive the immediate postoperative period. The balance between quality and quantity of life must be considered when weighing the options for the management of this condition.
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Affiliation(s)
- Neil S Horowitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Monneuse O, Gruner L, Henry L, Barth X, Olagne E, Beatrix O, Tissot E. [Hepatic portal venous gas]. ANNALES DE CHIRURGIE 2000; 125:435-8. [PMID: 10925484 DOI: 10.1016/s0003-3944(00)00217-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE Hepatic portal venous gas is a radiological symptom associated with a poor prognosis (75% to 90% mortality). The aim of this retrospective study was to report 7 cases observed over a 2-year period. PATIENTS AND METHOD From June 1997 to November 1999, hepatic portal venous gas was diagnosed in 6 patients by CT scan and in one patient by echosonography. It was not detected in any case by plain abdominal X-rays. Three patients had small bowel obstruction with necrosis, three had extensive superior mesenteric infarction and one had preperforative necrosis of the colon. RESULTS One patient with extensive intestinal infarction and a metastatic head and neck cancer was not operated. Two patients were operated, but the extensive mesenteric infarction was not amenable to surgical management. Three of the 7 patients died, while the other four patients survived after resection of the necrotic small intestine (n = 3) and left colectomy extended to the transverse colon (n = 1). CONCLUSION Hepatic portal venous gas was associated with intestinal necrosis in the seven cases of this series. The severity of portal venous gas is only correlated with the severity of the disease causing portal venous gas.
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Affiliation(s)
- O Monneuse
- Service d'urgence chirurgie viscérale, hôpital Edouard-Herriot, Lyon, France
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13
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Thomachot L, Arnal JM, Vialet R, Albanèse J, Martin C. [Lethal portal venous gas after cardiopulmonary arrest]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1998; 17:369-71. [PMID: 9750767 DOI: 10.1016/s0750-7658(98)80054-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We report the case of a 51-year-old patient admitted after a transient cardiorespiratory arrest. The abdominal CT scan revealed the presence of hepatic portal venous gas. At laparotomy, a diffuse mesenteric ischaemia was diagnosed. The patient died from multiple organ failure in the subsequent hours. Necrotic bowel is associated with hepatic portal venous gas in 50% of the cases and the current mortality rate is 85%. Gas originates either through intestinal transmucosal passage, either by intraportal bacterial gas production, or through both mechanisms.
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Affiliation(s)
- L Thomachot
- Département d'anesthésie-réanimation, hôpital Nord, Marseille, France
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Lee CS, Kuo YC, Peng SM, Lin DY, Sheen IS, Lin SM, Chuah SK, Chien RN. Sonographic detection of hepatic portal venous gas associated with suppurative cholangitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 1993; 21:331-334. [PMID: 8514901 DOI: 10.1002/jcu.1870210507] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- C S Lee
- Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Taipei, Taiwan, Republic of China
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15
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Spontaneous portal venous gas in a patient with Crohn's ileocolitis. GASTROINTESTINAL RADIOLOGY 1991; 16:38-40. [PMID: 1991607 DOI: 10.1007/bf01887301] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In a 70-year-old man with Crohn's ileocolitis who presented with a sudden fever, ultrasound and computed tomographic (CT) examinations showed hepatic portal venous gas (HPVG). Abdominal plain film was normal. The course was benign with medical management. The authors review previous cases of portal vein gas in intestinal inflammatory diseases.
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Abstract
Gas in the bowel wall is an unusual but important finding on an abdominal radiograph. The so-called "benign form," pneumatosis cystoides intestinalis, may be asymptomatic or may cause a variety of symptoms and can result in a bowel obstruction or a sterile pneumoperitoneum. On the other hand, intramural intestinal gas may represent severe underlying disease such as necrotizing enterocolitis or mesenteric vascular occlusion. This finding should be sought when examining abdominal radiographs. A thorough appreciation of the clinical significance of this unusual entity is necessary to make timely therapeutic decisions.
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Affiliation(s)
- J G Keene
- Department of Emergency Medicine, Saint Francis Hospital, Poughkeepsie, NY 12601
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17
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18
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Katz BH, Schwartz SS, Vender RJ. Portal venous gas following a barium enema in a patient with Crohn's colitis. A benign finding. Dis Colon Rectum 1986; 29:49-51. [PMID: 3940806 DOI: 10.1007/bf02555288] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Hepatic portal venous gas occurring during an air-contrast barium-enema examination in patients with inflammatory bowel disease is a benign finding. Patients with chronic ulcerative colitis have experienced some morbidity, while those with Crohn's colitis have not. It may not be necessary to treat all of these patients with antibiotics, especially asymptomatic patients with Crohn's colitis.
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19
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Benson MD. Adult survival with intrahepatic portal venous gas secondary to acute gastric dilatation, with a review of portal venous gas. Clin Radiol 1985; 36:441-3. [PMID: 4064538 DOI: 10.1016/s0009-9260(85)80339-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The radiological observation of hepatic portal venous gas on plain abdominal radiography, ultrasonography or computed tomography is a highly significant finding. Its cause warrants urgent diagnosis and will usually require surgical management. Current overall mortality rate associated with this sign is 75%. A case of acute gastric dilatation with hepatic portal venous gas in an adult who survived without surgery is presented. Patients having this sign after double-contrast barium enemas with quiescent inflammatory bowel disease have also been reported to survive without surgery.
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20
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Kranendonk SE, Bruining HA, van Urk H. Survival after portal venous gas due to mesenteric vascular occlusion. Br J Surg 1983; 70:183-4. [PMID: 6831162 DOI: 10.1002/bjs.1800700317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Gelfand DW. Complications of gastrointestinal radiologic procedures: I. Complications of routine fluoroscopic studies. GASTROINTESTINAL RADIOLOGY 1980; 5:293-315. [PMID: 7461407 DOI: 10.1007/bf01888650] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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22
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Sadhu VK, Brennan RE, Madan V. Portal vein gas following air-contrast barium enema in granulomatous colitis: report of a case. GASTROINTESTINAL RADIOLOGY 1979; 4:163-4. [PMID: 456831 DOI: 10.1007/bf01887517] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Portal vein gas developed in a patient with granulomatous colitis following air-contrast barium enema. No symptomatology or morbidity could be attributed to the portal vein gas in this patient.
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23
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Liebman PR, Patten MT, Manny J, Benfield JR, Hechtman HB. Hepatic--portal venous gas in adults: etiology, pathophysiology and clinical significance. Ann Surg 1978; 187:281-7. [PMID: 637584 PMCID: PMC1396434 DOI: 10.1097/00000658-197803000-00012] [Citation(s) in RCA: 296] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The roentgenographic finding hepatic--portal venous gas (HPVG) has been reported extensively in the pediatric and radiology literature. The surgical implications and clinical significance have yet to be fully defined. This study reviews the 60 reported cases in the literature and adds four new cases. HPVG appears as a branching radiolucency extending to within 2 cm of the liver capsule. HPVG is associated with necrotic bowel (72%), ulcerative colitis (8%), intra abdominal abscess (6%), small bowel obstruction (3%), and gastric ulcer (3%). Mucosal damage, bowel distention and sepsis predispose to HPVG. The current mortality rate of 75% represents an improvement from previous experience. Analysis of survivors indicates that the finding of HPVG requires urgent surgical exploration except when it is observed in patients with stable ulcerative colitis.
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Abstract
The roentgenographic finding hepatic--portal venous gas (HPVG) has been reported extensively in the pediatric and radiology literature. The surgical implications and clinical significance have yet to be fully defined. This study reviews the 60 reported cases in the literature and adds four new cases. HPVG appears as a branching radiolucency extending to within 2 cm of the liver capsule. HPVG is associated with necrotic bowel (72%), ulcerative colitis (8%), intra abdominal abscess (6%), small bowel obstruction (3%), and gastric ulcer (3%). Mucosal damage, bowel distention and sepsis predispose to HPVG. The current mortality rate of 75% represents an improvement from previous experience. Analysis of survivors indicates that the finding of HPVG requires urgent surgical exploration except when it is observed in patients with stable ulcerative colitis.
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Verby HD, Castellino RA, Friedland GW, Northway WH. Portal vein gas complicating Hirschsprung's disease with enterocolitis. The journal The Journal of Pediatrics 1968. [DOI: 10.1016/s0022-3476(68)80276-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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