A case of non-occlusive mesenteric ischemia and hepatic portal venous gas: not everyone knows that…

Contrast-enhanced ultrasonographic findings of non-occlusive mesenteric ischemia: a case series

PURPOSE

Diagnosis of non-occlusive mesenteric ischemia (NOMI) is difficult, with diagnostic imaging being mainly performed using angiography or contrast-enhanced computed tomography. Contrast-enhanced ultrasonography (CEUS) offers an alternative diagnostic method, although diagnosis of NOMI using CEUS is not common. In this report, we review CEUS findings in a series of patients with NOMI.

METHODS

The records of patients diagnosed with NOMI who underwent a surgical procedure in our institution between January 2015 and February 2020 were retrospectively assessed. Grayscale ultrasonography and CEUS findings were evaluated.

RESULTS

Ten patients (mean age 65 ± 25 years, 7 men) were studied. Grayscale ultrasonography revealed bowel dilatation, the presence of intestinal pneumatosis, portal venous gas, bowel wall thickening, and no or decreased peristalsis. A CEUS finding of note was a partial lack of enhancement of the bowel wall.

CONCLUSION

In a small case series of 10 patients with surgically/histopathology confirmed NOMI, partial lack of ultrasound contrast-enhancement of the bowel wall was observed.

Clinical Evaluation of Hepatic Portal Venous Gas after Abdominal Surgery

Hepatic portal venous gas (HPVG) is induced by various abdominal diseases. Since HPVG is accompanied by bowel ischemia, intestinal infection and hypovolemia, various modes of critical management are needed to treat the underlying conditions. HPVG associated with abdominal complications after surgery has rarely been reported. We present 4 patients with HPVG after abdominal surgery: 2 of the 4 patients died of multiple organ failure, and the other 2 recovered with solely conservative therapy. Although postoperative HPVG is a severe and life-threatening condition, early detection and systemic treatment lead to a better patient outcome.

Transient extensive hepatic portal venous gas following hypotension in a dialysis patient

A 68-year-old woman developed abdominal pain during a haemodialysis session and was transferred to our hospital. Although initial CT scan at former hospital detected extensive hepatic portal venous gas (HPVG), repeated CT scan on admission performed 2 h after the initial scan demonstrated a marked decrease in HPVG. Although HPVG is associated in some cases with bowel necrosis and high mortality, HPVG completely resolved within 18 h with only conservative treatment in presented case. Because recent increased use of CT scan allows early and highly sensitive detection of HPVG, not only in bowel necrosis, but also in non-life-threatening cases, we usually face a clinical dilemma whether to perform exploratory laparotomy. No previous studies have evaluated the duration of HPVG in detail, although this case suggests the value of CT scan follow-up in relatively stable patient even when the course of HPVG is short.