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Wei HR, Shan YQ, Dong FH, Zhou LP, Yang YB, Shi J, Ji CH, Kong WC. Clinical characteristics and treatment of hepatic portal venous gas: case series and literature review. Front Med (Lausanne) 2025; 12:1540418. [PMID: 40417673 PMCID: PMC12098563 DOI: 10.3389/fmed.2025.1540418] [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: 01/23/2025] [Accepted: 04/10/2025] [Indexed: 05/27/2025] Open
Abstract
Background Hepatic portal venous gas (HPVG) is often regarded as a critical warning sign and has poor patient prognosis if appropriate treatment measures are not promptly administered. There is significant heterogeneity in clinical manifestations, diagnostic approaches, and outcomes among patients with HPVG; hence, this study aimed to analyze the clinical characteristics of patients with HPVG and explore more effective treatment methods to provide valuable references for future clinical treatment strategies. Methods A total of 21 patients diagnosed with HPVG using computed tomography at the First People's Hospital of Hangzhou between January 2014 and October 2024 were retrospectively analyzed. A comprehensive analyses of the sex, age, laboratory test results, reasons for admission, comorbidities, treatment methods, and outcomes of patients were done. Results The mean age of the 21 patients (13 men and 8 women) was 61.7 years. Patients presented with decreased red blood cell and hemoglobin counts, and increased white blood cell, neutrophil, C-reactive protein, and D-dimer levels. The main etiologies of HPVG were peritonitis (52.4%), post-abdominal surgery (47.6%), intestinal necrosis (33.3%), and gastrointestinal bleeding (28.6%), while the common comorbidities were peritonitis (52.4%), hypertension (52.4%), and coronary heart disease (23.8%). The overall mortality rate of patients with HPVG was 28.6%, and most of the deceased patients had bowel necrosis. Platelet count [odds ratio (OR): 0.979; 95% confidence interval (CI): 0.962-0.997; p = 0.024] and neutrophil levels, (OR: 1.161; 95% CI: 1.019-1.323; p = 0.025), and the presence of hypertension (OR: 15.750; 95% CI: 1.424-174.246; p = 0.025) and peritonitis (OR: 15.750; 95% CI: 1.424-174.246; p = 0.025) were significantly associated with the likelihood of requiring surgical intervention. Most patients had a good prognosis after surgical treatment. Conclusion This study systematically described the clinical characteristics, etiologies, comorbidities, and prognosis of patients with HPVG and identified predictors indicating the need for surgical intervention.
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Affiliation(s)
- Hao-Ran Wei
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang, China
| | - Yu-Qiang Shan
- Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Zhejiang, China
| | - Fan-He Dong
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang, China
| | - Lin-Po Zhou
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang, China
| | - Ye-Bin Yang
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang, China
| | - Jing Shi
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang, China
| | - Cheng-Hao Ji
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang, China
| | - Wen-Cheng Kong
- Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Zhejiang, China
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Wu Y, Zhang Y, Fu J, Shen F. Hepatic portal venous gas after ingesting glyphosate: A case report and literature review. Heliyon 2024; 10:e36378. [PMID: 39253275 PMCID: PMC11382075 DOI: 10.1016/j.heliyon.2024.e36378] [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: 03/07/2023] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/11/2024] Open
Abstract
Background Glyphosate is a widely used herbicide. Clinical presentations of glyphosate intoxication show variation, but hepatic portal venous gas(HPVG) caused by glyphosate poisoning is rarely reported. Herein, we report a rare case of ominous HPVG after ingesting glyphosate. HPVG, which used to be an ominous abdominal radiologic sign, is associated with numerous underlying abdominal pathologies, ranging from benign conditions that require no invasive treatment to potentially lethal diseases that necessitate prompt surgical intervention. Case summary A young woman who ingested 100 mL glyphosate 6-h prior was admitted to the emergency intensive care unit. Before admission to our hospital, the patient was administered gastric lavage treatment with 10000 mL of normal saline in the local hospital. After 14 h, her laboratory examinations showed systemic inflammatory response syndrome and multiple organ dysfunction syndrome, while the condition deteriorated. Computed tomography of the abdomen showed multilinear air densities in the portal vein, hepatic branches, and mesenteric vessels, intestinal obstruction, and intestinal necrosis. Septic shock and a severe abdominal infection were diagnosed. The patient was treated conservatively as they could not tolerate surgery and, after 20 h died of septic shock. Conclusion We reviewed 289 cases of "hepatic portal venous gas" in PUBMED and analyzed the etiology and treatment of HPVG accompanied by the underlying pathology. We concluded that HPVG is a radiological sign associated with various diseases, and the prognosis mainly depends on the underlying cause and clinical condition. As glyphosate may erode the digestive tract, attention should be paid to the volume, pressure, and speed of gastric lavage in treating glyphosate poisoning to avoid fatal complications such as HPVG. Abdominal symptoms need to be closely observed, and changes in the early onset of the condition in clinical practice need to be responded to promptly.
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Affiliation(s)
- Yingxia Wu
- Department of Critical Care Medicine, Medical College of Soochow University, Suzhou, China
- Department of Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yijie Zhang
- Department of Emergency Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jiangquan Fu
- Department of Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Feng Shen
- Department of Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
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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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Fusaro L, Di Bella S, Martingano P, Crocè LS, Giuffrè M. Pylephlebitis: A Systematic Review on Etiology, Diagnosis, and Treatment of Infective Portal Vein Thrombosis. Diagnostics (Basel) 2023; 13:429. [PMID: 36766534 PMCID: PMC9914785 DOI: 10.3390/diagnostics13030429] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/20/2022] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
Pylephlebitis, defined as infective thrombophlebitis of the portal vein, is a rare condition with an incidence of 0.37-2.7 cases per 100,000 person-years, which can virtually complicate any intra-abdominal or pelvic infections that develop within areas drained by the portal venous circulation. The current systematic review aimed to investigate the etiology behind pylephlebitis in terms of pathogens involved and causative infective processes, and to report the most common symptoms at clinical presentation. We included 220 individuals derived from published cases between 1971 and 2022. Of these, 155 (70.5%) were male with a median age of 50 years. There were 27 (12.3%) patients under 18 years of age, 6 (2.7%) individuals younger than one year, and the youngest reported case was only 20 days old. The most frequently reported symptoms on admission were fever (75.5%) and abdominal pain (66.4%), with diverticulitis (26.5%) and acute appendicitis (22%) being the two most common causes. Pylephlebitis was caused by a single pathogen in 94 (42.8%) cases and polymicrobial in 60 (27.2%) cases. However, the responsible pathogen was not identified or not reported in 30% of the included patients. The most frequently isolated bacteria were Escherichia coli (25%), Bacteroides spp. (17%), and Streptococcus spp. (15%). The treatment of pylephlebitis consists initially of broad-spectrum antibiotics that should be tailored upon bacterial identification and continued for at least four to six weeks after symptom presentation. There is no recommendation for prescribing anticoagulants to all patients with pylephlebitis. However, they should be administered in patients with thrombosis progression on repeat imaging or persistent fever despite proper antibiotic therapy to increase the rates of thrombus resolution or decrease the overall mortality, which is approximately 14%.
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Affiliation(s)
- Lisa Fusaro
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Stefano Di Bella
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Infectious Disease Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34128 Trieste, Italy
| | - Paola Martingano
- Departmet of Radiology, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34128 Trieste, Italy
| | - Lory Saveria Crocè
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Liver Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34128 Trieste, Italy
| | - Mauro Giuffrè
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
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Seike T, Suda T, Oishi N. Conservative treatment of hepatic portal venous gas resulting from non-occlusive mesenteric ischemia: a case report. Clin J Gastroenterol 2021; 14:1404-1410. [PMID: 34173209 DOI: 10.1007/s12328-021-01468-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
A 73-year-old man with severe intellectual disability, malnutrition, and hypoalbuminemia presented to our hospital after experiencing vomiting following dinner. Electrocardiography revealed a sinus rhythm. Plain abdominal radiography showed branching radiolucency in the liver. Abdominal computed tomography (CT) revealed branching gaseous foci of low density in the portal vein and its tributaries, suggesting the presence of hepatic portal venous gas (HPVG). Abdominal contrast-enhanced CT showed a segmental lack of contrast enhancement in the intestinal wall despite the absence of vascular occlusion in the main trunk and branches of the mesenteric artery. The patient was diagnosed with non-occlusive mesenteric ischemia (NOMI) accompanied by HPVG. Peripheral parenteral nutrition, antibiotic treatment, and human serum albumin were administered. The HPVG disappeared approximately 20 h after hospitalization. Intravascular dehydration associated with hypoalbuminemia was considered to be the cause of NOMI; the latter improved through the early correction of dehydration and hypoalbuminemia. The presence of HPVG is usually considered a diagnostic clue in patients with abdominal catastrophe and is associated with high mortality. However, the current case demonstrates the pitfalls of assessing the severity of the underlying condition based solely on the presence of HPVG.
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Affiliation(s)
- Takuya Seike
- Department of Gastroenterology, Kanazawa Municipal Hospital, 3-7-3, Heiwa-machi, Kanazawa, Ishikawa, 921-8105, Japan.
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Tusyoshi Suda
- Department of Gastroenterology, Kanazawa Municipal Hospital, 3-7-3, Heiwa-machi, Kanazawa, Ishikawa, 921-8105, Japan
| | - Naoki Oishi
- Department of Gastroenterology, Kanazawa Municipal Hospital, 3-7-3, Heiwa-machi, Kanazawa, Ishikawa, 921-8105, Japan
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, 920-8641, 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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Abstract
We report the case of a 59-year old man with portomesenteric venous gas (PMVG) due to inferior mesenteric vein fistulization caused by sigmoid diverticulitis with an unusual evolution. The patient initially presented with classic symptoms of lower abdominal pain and fever. Diagnosis of uncomplicated sigmoid diverticulitis was confirmed on computed tomography (CT) for which intravenous antibiotics were initiated. Hemocultures were positive for omnisensitive Escherichia Coli, but despite adequate intravenous antibiotic therapy, episodes of bacteraemia persisted and hemocultures remained positive. Repeat CT scan demonstrated regression of inflammation without signs of abcedation or perforation consistent with clinical findings. Endocarditis was excluded with a normal transoesophageal echocardiography. Finally, positron emission tomography-computed tomography (PET-CT) suspected a colovenous fistula and the presence of PMVG. The patient was successfully treated with laparoscopic sigmoidectomy. This case report summarises the diagnostic pathway and aims for higher awareness of non-ischemic PMVG causes.
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Abstract
Objective
Diverticulosis is extremely common in western society. A recent study has shown that outpatient, nonantibiotic management of acute uncomplicated diverticulitis may be a feasible and safe option. However, the ability to identify these patients is still difficult. This study explores the ability of white cell count, C-reactive protein, and bilirubin in differentiating patients with complicated and uncomplicated diverticulitis, as well as progression to surgical intervention.
Methods
This is a retrospective study of patients admitted with acute diverticulitis over a 5-year period (2009–2014) at a single institution in Australia. Patients were classified into 3 groups; uncomplicated diverticulitis, complicated diverticulitis without surgery, and complicated diverticulitis with surgery. Analysis of variance (ANOVA) and Bonferroni's post hoc analyses were used to compare markers across the groups.
Results
A total of 541 patients met the inclusion criteria for this study. One-way ANOVA showed a significant difference in white cell count (P < 0.0001), C-reactive protein (P < 0.0001), and bilirubin (P = 0.0006) between all 3 groups. Post hoc analyses showed a significant difference in white cell count, C-reactive protein, and bilirubin when comparing uncomplicated diverticulitis against complicated diverticulitis without surgery (P < 0.05) and complicated diverticulitis with surgery (P < 0.05). White cell count also showed a significant difference when comparing complicated diverticulitis without surgery and complicated diverticulitis with surgery (P < 0.05).
Conclusions
White cell count, C-reactive protein, and bilirubin can distinguish between uncomplicated and complicated diverticulitis.
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Connor-Schuler R, Binz S, Clark C. Portal Venous Gas on Point-of-Care Ultrasound in a Case of Cecal Ischemia. J Emerg Med 2019; 58:e117-e120. [PMID: 31843320 DOI: 10.1016/j.jemermed.2019.10.033] [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: 06/22/2019] [Revised: 10/13/2019] [Accepted: 10/27/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Portal venous gas has mainly been studied in pediatrics and seen in cases of necrotizing enterocolitis. It is a rare finding in adults and is typically associated with underlying intestinal ischemia or other malignant intra-abdominal pathology. Portal venous gas is seen more readily on ultrasound compared to radiographs in both pediatric and adult patients. Findings include lucencies extending to the periphery of the liver, echogenic bubbles flowing centrifugally throughout the portal venous system, and bidirectional spikes interrupting the monophasic portal venous waveform on spectral analysis. CASE REPORT We present a case of a 36-year-old female who presented with abdominal pain. She had findings consistent with portal venous gas on point-of-care ultrasound, prompting computed tomography of her abdomen and surgical consultation. She was ultimately found to have cecal ischemia from cecal volvulus, had surgical resection and anastomosis, and was able to be discharged from the hospital following recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With the ever-increasing use of point-of-care ultrasound, emergency physicians should be aware of the findings consistent with portal venous gas as well as its implications. Emergency physicians should know portal venous gas is associated with intestinal ischemia and other malignant pathologies and should prompt more advanced imaging or surgical consultation when observed. Emergency physicians should also understand the distinctions between portal venous gas and pneumobilia found on point-of-care ultrasound, given that portal venous gas is typically a malignant finding and pneumobilia is most frequently benign.
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Affiliation(s)
- Randi Connor-Schuler
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, Georgia
| | - Sophia Binz
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan; Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Christopher Clark
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan
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Iatrogenic Hepatic Portal Venous Gas in a Patient With Crohn's Disease After Colonoscopy. ACG Case Rep J 2019; 6:e00150. [PMID: 31737693 PMCID: PMC6791633 DOI: 10.14309/crj.0000000000000150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/17/2019] [Indexed: 12/23/2022] Open
Abstract
Hepatic portal venous gas is a radiologic sign and is associated with several abdominal disorders. The prognosis and survival of the patient depends on the underlying etiology. Most cases respond to broad-spectrum antibiotics, but some may need surgical intervention. We report a case of hepatic portal venous gas after colonoscopy in a patient with Crohn's disease.
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Premkumar M, Rangegowda D, Kulkarni A, Vyas T, Dudha S, Maiwall R. Difficult to Treat Recurrent Pyogenic Cholangitis With Portal Pylephlebitis in the Setting of Idiopathic CD4+ Lymphocytopaenia. J Clin Exp Hepatol 2019; 9:749-752. [PMID: 31889757 PMCID: PMC6926195 DOI: 10.1016/j.jceh.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/17/2019] [Indexed: 12/12/2022] Open
Abstract
Recurrent pyogenic cholangitis (RPC) is a disease characterized by multiple strictures of the biliary tree, impaired biliary drainage, formation of intrahepatic biliary pigment stones and recurrent bouts of cholangitis. We report the case of a 39-year-old businessman with diagnosed chronic calcific pancreatitis, who presented to us with recurrent episodes of cholangitis, leading to portal pyaemia, and progressive liver failure, which could not be controlled despite adequate biliary drainage. The patient rapidly developed progressive liver failure and sepsis-related coagulation failure. He was also found to have idiopathic CD4+ T cell lymphocytopenia (ICL), which resulted in refractory sepsis and formation of metastatic abscesses in the lung and spleen. ICL is now recognised in patients with recurrent and difficult to treat opportunistic infections. The combination of RPC, sepsis and liver failure in the setting of an acquired immunosuppressed state makes this a unique management scenario.
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Affiliation(s)
- Madhumita Premkumar
- Address for correspondence: Madhumita Premkumar, MD, DM, Senior Resident, Department of Hepatology, ILBS, D-1 Vasant Kunj, 110070, New Delhi, India.
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Capolupo GT, Mascianà G, Carannante F, Caricato M. Hepatic portal venous gas after colonoscopy: A case report and review. Int J Surg Case Rep 2018; 51:54-57. [PMID: 30144710 PMCID: PMC6107896 DOI: 10.1016/j.ijscr.2018.06.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/06/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Hepatic portal venous gas (HPVG) is a rare radiological finding in which gas enters the portal venous system and it is associated in case of necrotizing colitis with a mortality of 75%. We report a case of iatrogenic HPVG with a review of literature. PRESENTATION OF CASE A 41 years old patient underwent total colectomy and ileal pouch- anal anastomosis with derivative ileostomy for a familiar adenomatous polyposis coli in June 2008. A stenosis of the pouch-anal anastomosis developed. The patient underwent several endoscopic dilations. A recurrence of the stenosis was observed. The patient underwent to several endoscopic procedure. After the last colonoscopy the patient showed a fever with abdominal pain. A CT scan showed little peri-anastomotic collections and massive hepatic portal venous gas. DISCUSSION The management of HPVG varied from surgical intervention to non-operative procedure. The surgical approach it's reserved to clinically unstable patients or those with evidence of peritonitis or bowel perforation. Stable patients, like those with an HPVG consequence of an endoscopic procedure, can be treated with non- operative management. CONCLUSION Our experience confirm that hepatic portal venous gas can be related to endoscopic procedure; thus, it can be managed on the basis of patient's general clinical conditions, and in selected cases it will disappear without therapeutic interventions with a good outcome.
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Affiliation(s)
- G T Capolupo
- Institute of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21 - 00128 Rome, Italy
| | - G Mascianà
- Institute of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21 - 00128 Rome, Italy.
| | - F Carannante
- Institute of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21 - 00128 Rome, Italy
| | - M Caricato
- Institute of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21 - 00128 Rome, Italy
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Yates TAE, Pasipanodya A, Sathyanarayana SA. Portomesenteric Venous Gas Secondary to Acute Diverticulitis Colovenous Fistula. Am Surg 2018. [DOI: 10.1177/000313481808400403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Moussa M, Marzouk I, Abdelmoula K, Manamani A, Dali N, Farhat LCB, Hendaoui L. Role of Computed tomography in predicting prognosis of Hepatic portal venous gas. Int J Surg Case Rep 2016; 30:177-182. [PMID: 28012340 PMCID: PMC5198631 DOI: 10.1016/j.ijscr.2016.11.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/28/2016] [Indexed: 12/31/2022] Open
Abstract
When hepatic portal venous gas is diagnosed on computed tomography, the first etiology that radiologist should look for is the intestinal necrosis. The association of hepatic portal venous gas and pneumatosis intestinalis is highly suggestive of acute mesenteric ischemia. Abundance of hepatic portal venous gas on CT is not correlated with prognosis.
Background The aim of this study was to report through 13 cases the particularities of abdominal computed tomography (CT) aspects of hepatic portal venous gas (HPVG) and its correlation with patient prognosis. Methods We analyzed abundance of HPVG and its association with pneumatosis intestinalis (PI) in correlation with fatal outcome using chi-square tests. Results Etiologies were mesenteric infarction (n = 5), sigmoid diverticulitis (n = 1), septic shock (n = 1), postoperative peritonitis (n = 1), acute pancreatitis (n = 1), iatrogenic cause (n = 3) and idiopathic after a laparotomy (n = 1). The outcome was fatal in for 6 patients. Abundance of HPV was expressed in total number of hepatic segments involved. The involvement of 3 or more segments was a sensitive sign for lethal outcome with high sensitivity (100%) but it was not specific (50%). Negative predictive value of this sign was 100% (p ≤ 0.005). Positive predictive value of PI for death was 100% (p ≤ 0.001). Discussion Abundance of HPVG is correlated with prognosis. The presence of PI announces poor outcome Negative predictive value of presence of HPVG in 3 or more segments is interesting. Predicting prognosis with CT can help surgeons to assess the most adequate treatment. Iatrogenic causes are increasingly described after interventional radiology procedures with favorable course. Conclusion The first etiology radiologists should look for in front of HPVG involving more than 3 hepatic segments and associated with PI is intestinal necrosis which announces a poor prognosis. This study shows that outside of shock situations, HPVG involving 2 or less hepatic segments without PI predicts a good outcome.
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Affiliation(s)
- Makram Moussa
- Department of Surgery, University Hospital of Bizerta, Tunisia.
| | - Inès Marzouk
- Department of Diagnostic and Interventional Radiology, University Hospital Mongi Slim Marsa, Tunisia
| | - Kais Abdelmoula
- Department of Diagnostic and Interventional Radiology, University Hospital Mongi Slim Marsa, Tunisia
| | - Amira Manamani
- Department of Diagnostic and Interventional Radiology, University Hospital Mongi Slim Marsa, Tunisia
| | - Nadida Dali
- Department of Diagnostic and Interventional Radiology, University Hospital Mongi Slim Marsa, Tunisia
| | - Leila Charrada Ben Farhat
- Department of Diagnostic and Interventional Radiology, University Hospital Mongi Slim Marsa, Tunisia
| | - Lotfi Hendaoui
- Department of Diagnostic and Interventional Radiology, University Hospital Mongi Slim Marsa, Tunisia
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Solakoglu T, Sari SO, Koseoglu H, Basaran M, Akar M, Buyukasik S, Ersoy O. A case of hepatic portal venous gas after colonoscopy. Arab J Gastroenterol 2016; 17:140-142. [PMID: 27658328 DOI: 10.1016/j.ajg.2016.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 01/01/2016] [Accepted: 08/20/2016] [Indexed: 11/26/2022]
Abstract
Hepatic portal venous gas (HPVG) is a rare radiologic finding that is usually precipitated by intestinal ischaemia, intra-abdominal abscesses, necrotising enterocolitis, abdominal trauma, infectious enteritis, and inflammatory bowel disease. In this study, we present a case of HPVG in a 66-year-old female patient who underwent colonoscopy for evaluation of haematochezia and a review of the literature focused on HPVG following colonoscopy.
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Affiliation(s)
- Tevfik Solakoglu
- Department of Gastroenterology, Corlu State Hospital, Corlu, Tekirdag, Turkey.
| | - Sevil O Sari
- Department of Gastroenterology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Huseyin Koseoglu
- Department of Gastroenterology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Murat Basaran
- Department of Gastroenterology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Mustafa Akar
- Department of Gastroenterology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Semnur Buyukasik
- Department of Gastroenterology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Osman Ersoy
- Department of Gastroenterology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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Moser A, Stauffer A, Wyss A, Schneider C, Essig M, Radke A. Conservative treatment of hepatic portal venous gas consecutive to a complicated diverticulitis: A case report and literature review. Int J Surg Case Rep 2016; 23:186-9. [PMID: 27180229 PMCID: PMC5022071 DOI: 10.1016/j.ijscr.2016.04.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION AND PRESENTATION OF CASE Eight days after being diagnosed with multiple small strokes a 71year old male patient is readmitted with suspicion of a petit mal seizure also complained of diarrhoea and abdominal pain. The patient was stable, not febrile and neurologically intact with a slight tenderness in the left lower quadrant. An ultrasound revealed presence of air in the hepatic portal venous system and a suspicion for sigmoid diverticulitis. A CT-scan confirmed both diagnoses. We proceeded with a conservative regimen under close observation. The clinical course and laboratory results were unremarkable. DISCUSSION The review of the literature (PubMed database) triggered 685 items with only one clinical trial establishing a scoring system to detect adult individuals, which need operation. CONCLUSION A pneumoportogram (hepatic portal venous gas, HPVG) is a very rare and usually associated with bowel ischemia and from poor prognosis. The last decades saw the emergence of numerous other aetiologies (also benign) with a shift of paradigm from systematic emergency laparotomies to individual patient selection.
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Affiliation(s)
- Alexandre Moser
- Department of Internal Medicine, Hospital of Zweisimmen, Switzerland.
| | - Anita Stauffer
- Department of Internal Medicine, Hospital of Zweisimmen, Switzerland
| | - André Wyss
- Department of Radiology, Hospital of Thun, Switzerland
| | - Claudio Schneider
- University Clinic for General Internal Medicine, University Hospital of Bern, Switzerland
| | - Manfred Essig
- Department of Internal Medicine, Hospital of Zweisimmen, Switzerland
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Seak CJ, Ng CJ, Yen DHT, Wong YC, Hsu KH, Seak JCY, Seak CK. Performance assessment of the Simplified Acute Physiology Score II, the Acute Physiology and Chronic Health Evaluation II score, and the Sequential Organ Failure Assessment score in predicting the outcomes of adult patients with hepatic portal venous gas in the ED. Am J Emerg Med 2014; 32:1481-4. [PMID: 25308825 DOI: 10.1016/j.ajem.2014.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/02/2014] [Accepted: 09/09/2014] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE This study aims to evaluate the performance of Simplified Acute Physiology Score II (SAPS II), the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the Sequential Organ Failure Assessment (SOFA) score for predicting illness severity and the mortality of adult hepatic portal venous gas (HPVG) patients presenting to the emergency department (ED). This will assist emergency physicians in risk stratification. METHODS Data for 48 adult HPVG patients who visited our ED between December 2009 and December 2013 were analyzed. The SAPS II, APACHE II score, and SOFA score were calculated based on the worst laboratory values in the ED. The probability of death was calculated for each patient based on these scores. The ability of the SAPS II, APACHE II score, and SOFA score to predict group mortality was assessed by using receiver operating characteristic curve analysis and calibration analysis. RESULTS The sensitivity, specificity, and accuracy were 92.6%,71.4%, and 83.3%, respectively, for the SAPS II method; 77.8%, 81%, and 79.2%, respectively, for the APACHE II scoring system, and 77.8%, 76.2%, and 79.2%, respectively, for the SOFA score. In the receiver operating characteristic curve analysis, the areas under the curve for the SAPS II, APACHE II scoring system, and SOFA score were 0.910, 0.878, and 0.809, respectively. CONCLUSION This is one of the largest series performed in a population of adult HPVG patients in the ED. The results from the present study showed that SAPS II is easier and more quickly calculated than the APACHE II and more superior in predicting the mortality of ED adult HPVG patients than the SOFA. We recommend that the SAPS II be used for outcome prediction and risk stratification in adult HPVG patients in the ED.
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Affiliation(s)
- Chen-June Seak
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - David Hung-Tsang Yen
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yon-Cheong Wong
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuang-Hung Hsu
- Laboratory for Epidemiology, Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
| | | | - Chen-Ken Seak
- Sarawak General Hospital, Kuching, Sarawak, Malaysia
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Seak CJ, Hsu KH, Wong YC, Ng CJ, Yen DHT, Seak JCY, Seak CK. The prognostic factors of adult patients with hepatic portal venous gas in the ED. Am J Emerg Med 2014; 32:972-5. [PMID: 25043627 DOI: 10.1016/j.ajem.2014.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/27/2014] [Accepted: 05/07/2014] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the prognostic factors of adult patients with hepatic portal venous gas (HPVG) in the emergency department (ED) to facilitate clinical decision making by emergency physicians. METHODS Data from adult patients with HPVG who visited our ED between December 2009 and December 2013 were analyzed. The computed tomographic scan images were reviewed, and the presence of HPVG with or without pneumatosis intestinalis (PI) was confirmed by a certified radiologist. The study end point was mortality or survival upon discharge. The factors associated with mortality were specifically analyzed with multiple logistic regression models. RESULTS Among the total of 50 HPVG patients, the overall mortality rate was 56%. No deaths were observed among the patients with neither shock nor PI in the ED. Shock (odds ratio, 17.02; 95% confidence interval, 3.36-86.22) and PI (odds ratio, 5.14; 95% confidence interval, 1.03-25.67) were determined to be significant predictors of patient mortality after adjusting for age and sex. The mortality of the patients with both shock and PI was very high (84%). CONCLUSIONS Early resuscitation should be initiated for the prevention of shock in adult patients with HPVG in the ED. To enhance the chance for survival, the prompt consultation of surgeons for emergency operations should be considered for adult ED patients exhibiting both shock and PI, which may indicate true ischemic bowel disease.
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Affiliation(s)
- Chen-June Seak
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Hung Hsu
- Laboratory for Epidemiology, Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yon-Cheong Wong
- Chang Gung University, Taoyuan, Taiwan; Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan.
| | - David Hung-Tsang Yen
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | | | - Chen-Ken Seak
- Sarawak General Hospital, Kuching, Sarawak, Malaysia
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Perez JT, Alberti N, Salut C, Frulio N, Trillaud H. Sigmoid diverticulitis with inferior mesenteric vein fistula. Diagn Interv Imaging 2013; 95:321-2. [PMID: 24231343 DOI: 10.1016/j.diii.2013.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J-T Perez
- Service de radiologie, hôpital Saint-André, 1, rue Burguet, 33075 Bordeaux, France.
| | - N Alberti
- Service de radiologie, hôpital Saint-André, 1, rue Burguet, 33075 Bordeaux, France
| | - C Salut
- Service de radiologie, hôpital Saint-André, 1, rue Burguet, 33075 Bordeaux, France
| | - N Frulio
- Service de radiologie, hôpital Saint-André, 1, rue Burguet, 33075 Bordeaux, France
| | - H Trillaud
- Service de radiologie, hôpital Saint-André, 1, rue Burguet, 33075 Bordeaux, France
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Nomura S, Watanabe M, Komine O, Shioya T, Toyoda T, Bou H, Shibuya T, Suzuki H, Uchida E. Serum total bilirubin elevation is a predictor of the clinicopathological severity of acute appendicitis. Surg Today 2013; 44:1104-8. [PMID: 23880964 DOI: 10.1007/s00595-013-0659-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/03/2013] [Indexed: 01/26/2023]
Abstract
PURPOSE Elevation of the serum total bilirubin (STB) level not stemming from hepatic dysfunction or biliary obstruction may be seen in cases of acute appendicitis. This paper deals with the clinical significance of such elevations. METHODS Data from 410 appendectomized patients classified into two groups (a high preoperative STB group and a normal preoperative STB group) were analyzed to reveal the significance of preoperative hyperbilirubinemia. We also examined whether the preoperative STB level might serve as a risk factor for gangrenous appendicitis by a multivariate analysis. RESULTS Gangrenous appendicitis was more common in the high preoperative STB group (p < 0.001). The multivariate analysis revealed that an elevated preoperative STB level (odds ratio 1.7919) was a risk factor for gangrenous appendicitis. CONCLUSION In patients with an elevated preoperative STB level, it is very likely that the inflammation is severe and that the disease has progressed to a severe condition histopathologically; therefore, meticulous attention should be paid to the selection of the surgical procedure, as well as to the postoperative clinical course.
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Affiliation(s)
- Satoshi Nomura
- Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital, 1-396, Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
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Duran R, Denys AL, Letovanec I, Meuli RA, Schmidt S. Multidetector CT features of mesenteric vein thrombosis. Radiographics 2013; 32:1503-22. [PMID: 22977032 DOI: 10.1148/rg.325115100] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mesenteric vein thrombosis (MVT) accounts for 5%-15% of all mesenteric ischemic events and is classified as either primary or secondary. Primary MVT is idiopathic, whereas secondary MVT can result from a variety of underlying diseases and risk factors, including primary hypercoagulable states or prothrombotic disorders, myeloproliferative neoplasms, cancer (most frequently of the pancreas or liver), diverse inflammatory conditions, recent surgery, portal hypertension, and miscellaneous causes such as oral contraceptives or pregnancy. Clinical symptoms of MVT are rather nonspecific and are mainly characterized by abdominal pain. The mortality rate for MVT remains high, since even now the diagnosis is often delayed. Multidetector computed tomography (CT) is the modality of choice in this context. Although venous bowel ischemia occurs only infrequently with MVT, radiologists should be familiar with its multidetector CT features. Familiarity with the possible causes of MVT, the underlying pathogenic mechanisms associated with MVT, and the correlation between multidetector CT features and these pathogenic mechanisms is necessary to optimize medical management and improve patient care.
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Affiliation(s)
- Rafael Duran
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Käser SA, Fankhauser G, Glauser PM, Toia D, Maurer CA. Diagnostic value of inflammation markers in predicting perforation in acute sigmoid diverticulitis. World J Surg 2011; 34:2717-22. [PMID: 20645093 DOI: 10.1007/s00268-010-0726-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The importance of inflammation markers in predicting perforation in acute sigmoid diverticulitis is not well known. Predicting perforation by clinical examination alone may be hazardous. If perforation is suspected, then appropriate diagnostic tools such as computed tomography (CT) are indicated, and surgical intervention might be necessary. METHODS A cohort of consecutive patients with acute sigmoid diverticulitis diagnosed by CT and with complete laboratory findings (n = 247) were retrospectively divided into two groups, one with perforation (n = 86) and another without (n = 161). The latest values of C-reactive protein (CRP), white blood cell count (WBC), and serum bilirubin, as well as the activity of the alkaline phosphatase (AP) measured during the 48 h period before the CT scan, were assessed. RESULTS In the Wilcoxon rank sum test CRP and WBC correlate significantly (p < 0.05) with perforation in acute sigmoid diverticulitis, whereas the logistic regression model shows only CRP to correlate significantly (p = 0.001) with perforation. The sensitivities/specificities for perforation are 98%/5% for elevated CRP (>5 mg/l), 86%/27% for a CRP higher than 50 mg/l, 44%/81% for a CRP higher than 150 mg/l, 28%/93% for a CRP higher than 200 mg/l, 88%/44% for elevated WBC (>10 × 10(9)/l), 35%/90% for hyperbilirubinemia (>20 μmol/l), and 35%/91% for elevated AP (>110 U/l). CONCLUSIONS A CRP below 50 mg/l suggests a perforation to be unlikely in acute sigmoid diverticulitis, whereas a CRP higher than 200 mg/l is a strong indicator of perforation.
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Affiliation(s)
- S A Käser
- Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Liestal, Rheinstrasse 26, 4410, Liestal, Switzerland
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Kanellopoulou T, Alexopoulou A, Theodossiades G, Koskinas J, Archimandritis AJ. Pylephlebitis: an overview of non-cirrhotic cases and factors related to outcome. ACTA ACUST UNITED AC 2010; 42:804-11. [PMID: 20735334 DOI: 10.3109/00365548.2010.508464] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pylephlebitis is a condition with significant morbidity and mortality. We review herein 100 relevant case reports published since 1971. Eighty-one patients were reported with acute pylephlebitis, while the remaining patients had chronic pylephlebitis. The most common predisposing infections leading to pylephlebitis were diverticulitis and appendicitis. Cultures from blood or other tissues were positive in 77%. The infection was polymicrobial in half of the patients and the most common isolates were Bacteroides spp, Escherichia coli and Streptococcus spp. Thrombosis was extended to the superior mesenteric vein (SMV), splenic vein, and intrahepatic branches of the portal vein (PV) in 42%, 12%, and 39%, respectively. Antibiotics were administered in all and anticoagulation in 35 cases. Patients who received anticoagulation had a favourable outcome compared to those who received antibiotics alone (complete recanalization 25.7% vs 14.8% (p > 0.05), no recanalization 5.7% vs 22.2% (p < 0.05), and death 5.7% vs 22.2% (p < 0.01)). Cases with complete recanalization had prompt diagnosis and management and two-thirds were recently published. Nineteen patients died; the majority of these (73.7%) died over the period 1971-1990. In conclusion, pylephlebitis remains an entity with high morbidity and mortality, but modern imaging modalities have facilitated an earlier diagnosis and have improved the prognosis. Anticoagulation has a rather beneficial effect on patients with pylephlebitis.
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Affiliation(s)
- Theoni Kanellopoulou
- Second Department of Medicine, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
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Alcock J, Brainard AH. Gene–environment mismatch in decompression sickness and air embolism. Med Hypotheses 2010; 75:199-203. [DOI: 10.1016/j.mehy.2010.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Accepted: 02/17/2010] [Indexed: 02/04/2023]
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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; 15:3585-3590. [PMID: 19653334 PMCID: PMC2721230 DOI: 10.3748/wjg.15.3585] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Revised: 07/07/2009] [Accepted: 07/14/2009] [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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Şen M, Akpınar A, İnan A, Şişman M, Dener C, Akın K. Extensive hepatic-portal and mesenteric venous gas due to sigmoid diverticulitis. World J Gastroenterol 2009; 15:879-81. [PMID: 19230052 PMCID: PMC2653391 DOI: 10.3748/wjg.15.879] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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 is most often associated with extensive bowel necrosis due to mesenteric infarction. Mortality exceeds 75% with this condition. The most common precipitating factors include ischemia, intra-abdominal abscesses and inflammatory bowel disease. In this report, we present a 75-year-old woman with extensive hepatic portal and mesenteric venous gas due to colonic diverticulitis. She had a 10-year history of type II diabetes mellitus and hypertension. She was treated by sigmoid resection and Hartmann’s procedure and discharged from the hospital without any complications.
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Hussain A, Mahmood H, El-Hasani S. Portal vein gas in emergency surgery. World J Emerg Surg 2008; 3:21. [PMID: 18637169 PMCID: PMC2490689 DOI: 10.1186/1749-7922-3-21] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 07/17/2008] [Indexed: 12/22/2022] Open
Abstract
Background Portal vein gas is an ominous radiological sign, which indicates a serious gastrointestinal problem in the majority of patients. Many causes have been identified and the most important was bowel ischemia and mesenteric vascular accident. The presentation of patients is varied and the diagnosis of the underlying problem depends mainly on the radiological findings and clinical signs. The aim of this article is to show the clinical importance of portal vein gas and its management in emergency surgery. Methods A computerised search was made of the Medline for publications discussing portal vein gas through March 2008. Sixty articles were identified and selected for this review because of their relevance. These articles cover a period from 1975–2008. Results Two hundreds and seventy-five patients with gas in the portal venous system were reported. The commonest cause for portal vein gas was bowel ischemia and mesenteric vascular pathology (61.44%). This was followed by inflammation of the gastrointestinal tract (16.26%), obstruction and dilatation (9.03%), sepsis (6.6%), iatrogenic injury and trauma (3.01%) and cancer (1.8%). Idiopathic portal vein gas was also reported (1.8%). Conclusion Portal vein gas is a diagnostic sign, which indicates a serious intra-abdominal pathology requiring emergency surgery in the majority of patients. Portal vein gas due to simple and benign cause can be treated conservatively. Correlation between clinical and diagnostic findings is important to set the management plan.
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Affiliation(s)
- Abdulzahra Hussain
- General surgery department, Princess Royal University Hospital, Greater London, UK.
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