1
|
Transient portal venous gas in upper gastrointestinal bleeding: A case report. Radiol Case Rep 2022; 17:4260-4263. [PMID: 36120516 PMCID: PMC9474283 DOI: 10.1016/j.radcr.2022.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 12/02/2022] Open
Abstract
Portal venous gas (PVG) or hepatic portal venous gas (HPVG) is the accumulation of gas in the portal vein and its branches. HPVG may be considered as a nonspecific sign of a significant abdominal disease, ranging from potentially lethal diseases to benign conditions. Computed tomography (CT) can detect both the presence of gas and the underlying pathology. I report a 60-year-old male who presented to the emergency department with upper gastrointestinal bleeding and a high lactate level in the blood test. Because of the unknown etiology for the elevated lactate, a CT scan of the abdomen was taken, which showed that he developed intra-and extra-hepatic portal venous gas as well as in the portomesentric-portosystemic collaterals without any signs of mesenteric ischemia. The patient was treated conservatively and the HPVG completely resolved after a few days. Overall, physicians must be aware that prognosis is related to the pathology itself and is not influenced by the presence of PVG. HPVG can be caused by several benign conditions that do not necessarily require urgent exploratory laparotomy.
Collapse
|
2
|
Muacevic A, Adler JR. A Case Report on Hepatic Portal Venous Gas (HPVG). Cureus 2022; 14:e30689. [PMID: 36320790 PMCID: PMC9597268 DOI: 10.7759/cureus.30689] [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] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Hepatic Portal Venous Gas (HPVG) is the abnormal presence of gas in the portal venous system. It is associated with life-threatening conditions and is a sinister radiological sign. This case report aims to evaluate the significance of HPVG as a radiological sign. Our case involves a 49-year-old man who was admitted to the hospital following a one-day history of severe epigastric pain and haematemesis. Investigations showed extensive HPVG, gastric pneumatosis, a large retroperitoneal haematoma, and an obstructive lesion between the first and second part of the duodenum. Our patient was managed conservatively in the High Dependency Unit (HDU). A repeat Computerised Tomography (CT) scan showed successful resolution of the HPVG and gastric pneumatosis without any invasive intervention.
Collapse
|
3
|
Zorzetti N, Lauro A, Ruffato A, D'Andrea V, Ferruzzi L, Antonacci N, Tranchino RM. Gas in the Portal Vein: An Emergency or Just Hot Air? Dig Dis Sci 2021; 66:3290-3295. [PMID: 34189669 DOI: 10.1007/s10620-021-07126-8] [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] [Accepted: 06/16/2021] [Indexed: 12/17/2022]
Abstract
We report the case of a 87-year-old woman admitted to our Emergency Department for mild abdominal pain associated with vomiting. An abdominal X-ray showed gas present in the portal venules of the left hepatic lobe, a finding associated with numerous surgical and medical conditions. The patient was successfully managed with conservative treatment. Isolated intrahepatic gas is a rare radiologic finding; emergency surgery should be performed only when there are signs of associated acute intestinal infarction.
Collapse
Affiliation(s)
- N Zorzetti
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy.
| | - A Lauro
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - A Ruffato
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - V D'Andrea
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - L Ferruzzi
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - N Antonacci
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - R M Tranchino
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| |
Collapse
|
4
|
Yamada S, Koitabashi K, Sakurada T. Portomesenteric venous gas: An unusual complication of peritoneal dialysis. Ther Apher Dial 2020; 24:735-736. [DOI: 10.1111/1744-9987.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/08/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Shohei Yamada
- Division of Nephrology and Hypertension Department of Internal Medicine, St. Marianna University School of Medicine Kawasaki Japan
| | - Kenichiro Koitabashi
- Division of Nephrology and Hypertension Department of Internal Medicine, St. Marianna University School of Medicine Kawasaki Japan
| | - Tsutomu Sakurada
- Division of Nephrology and Hypertension Department of Internal Medicine, St. Marianna University School of Medicine Kawasaki Japan
| |
Collapse
|
5
|
Sumner B, Bonadio W, Hahn C. Hepatic Portal Venous Gas Incidentally Associated With Bacterial Enteritis: A Case Report. Cureus 2020; 12:e10219. [PMID: 33042664 PMCID: PMC7535866 DOI: 10.7759/cureus.10219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hepatic portal venous gas (HPVG) has long been associated with catastrophic intraabdominal conditions. Advancements in ultrasound (US) and computed tomography (CT) imaging have resulted in an increased number of incidental and clinically benign HPVG cases identified. Causes of clinically benign HPVG include viral gastroenteritis, gastritis, pancreatitis, appendicitis and diverticulitis. Our case demonstrates the first reported case of HPVG in an adolescent patient associated with enteropathogenic E. coli (EPEC). The patient’s course was favorable, marked by a short stay in the pediatric intensive care unit (ICU) and did not require surgical intervention. With higher sensitivity of imaging modalities to diagnose both suspected and incidental cases of HPVG, clinicians will be required to consider the risks and benefits of conservative treatment or surgical intervention.
Collapse
|
6
|
A case with hepatic portal vein gas who required delayed elective surgery. Int J Surg Case Rep 2019; 65:233-237. [PMID: 31734474 PMCID: PMC6864318 DOI: 10.1016/j.ijscr.2019.10.085] [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: 09/20/2019] [Revised: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 01/16/2023] Open
Abstract
Hepatic portal venous gas (HPVG) is believed to be an indication for emergent surgery because it is associated with high mortality rate. The recent increase in the use of modern abdominal CT has resulted in the detection of HPVG in more benign conditions. The decision-making process whether we choose emergent surgery or conservative treatment without surgery is important for the patients with HPVG. The case with portal hepatic vein gas (HPVG) presented in this article required delayed elective surgery after conservative treatment. This case show the subtle difference comparing with the other case who were successfully treated without surgery.
Introduction Hepatic portal venous gas (HPVG) is believed to be an indication for emergent surgery because it is associated with high mortality rate. However, the recent increase in the use of modern abdominal computed tomography (CT) has resulted in the detection of HPVG in more benign conditions. Therefore, the decision-making process whether we chose emergent surgery or conservative treatment without surgery is important for the patients with HPVG. Case presentation An 84-year-old male was referred to our hospital due to the sudden onset of abdominal pain and massive hepatic portal vein gas on emergent CT. The Acute Physiology and Chronic Health Evaluation (APACHE) II Score was calculated as 17; slightly elevated comparing with the other cases who were successfully treated without surgery. Although the PHVG was remained at follow up CT on the next day after the onset, the symptoms were improved. We selected conservative treatment without emergent surgery and he discharged on 9th day after the onset. However, he was suffered from right lower abdominal pain and vomiting and admitted our hospital on 23th day. He developed ischemic intestinal stenosis and underwent a surgery of partial resection of ileum. Conclusions The clinical finding of this case showing subtle differences from cases who were successfully treated without surgery. We hope this report will help physician’s decision-making process for HPVG.
Collapse
|
7
|
Hong I, Hong SW, Chang YG, Lee B, Lee WY, Ohe HJ, Kim YK. Successful Conservative Management of Hepatic Portal Venous Gas due to Anastomosis Leakage After a Sigmoidectomy. Ann Coloproctol 2019:282-284. [PMID: 30678448 PMCID: PMC6863010 DOI: 10.3393/ac.2018.03.23.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/23/2018] [Indexed: 11/06/2022] Open
Abstract
In past decades, hepatic portal venous gas (HPVG) has rarely been reported, and the mortality rate has been very high. In most cases, surgical intervention was needed. Presently, abdominal computed tomography can be conveniently used to diagnose HPVG, which has various underlying causes and benign courses. We present the case of a patient with HPVG due to anastomosis leakage after a sigmoidectomy for diverticulitis; the patient was cured with conservative management.
Collapse
Affiliation(s)
- Injae Hong
- Department of Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Seong Woo Hong
- Department of Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Yeo Gu Chang
- Department of Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Byungmo Lee
- Department of Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Woo Yong Lee
- Department of Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Haeng Jin Ohe
- Department of Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Young Ki Kim
- Department of Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| |
Collapse
|
8
|
Tahara S, Sakai Y, Katsuno H, Urano M, Kuroda M, Tsukamoto T. Pneumatosis intestinalis and hepatic portal venous gas associated with gas-forming bacterial translocation due to postoperative paralytic ileus: A case report. Medicine (Baltimore) 2019; 98:e14079. [PMID: 30633214 PMCID: PMC6336625 DOI: 10.1097/md.0000000000014079] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
RATIONALE Pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) are rare but potentially lethal conditions in which gas pathologically accumulates in the portal vein and intestinal wall, respectively. Proposed mechanisms include flatus escaping through an injured intestinal mucosa into the submucosa and thence into the portal venous system, or bacterial translocation (BT) of gas-forming enteric microorganisms from the gut into and through the intestinal wall to other organs. However, there has been no clear histopathological evidence to support these hypotheses. PATIENT CONCERNS A 61-year-old man underwent sigmoidectomy for colonic adenocarcinoma. Postoperatively, he developed paralytic ileus and then had a sudden cardiopulmonary arrest. DIAGNOSES PI and HPVG were found at autopsy, presumably caused by the postoperative paralytic ileus and associated with BT of gas-forming organisms. INTERVENTIONS Cardiopulmonary resuscitation was unsuccessful. OUTCOMES Postmortem imaging indicated the presence of massive PI and HPVG. At autopsy, there was marked intestinal emphysema with diffuse ischemic mucosal necrosis and severe pneumatosis in the stomach and intestine and marked gaseous dilation of the intrahepatic portal veins. Postmortem bacterial cultures revealed enteric bacteria in the peripheral blood and liver tissue. LESSONS Postoperative ileus leading to intestinal mucosal damage may be associated with BT of gas-forming enteric bacteria and the rapid onset of PI and HPVG with a lethal outcome.
Collapse
Affiliation(s)
| | | | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | | | | | | |
Collapse
|
9
|
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: 9] [Impact Index Per Article: 1.5] [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
Here we reported a rare case of hepatic portal venous gas with a relevant review of literature. Actually the mechanism of HPVG is still unknown. The case present in literature are few and the mortality, generally caused by complications like necrotizing enterocolitis, is still high.
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.
Collapse
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
| |
Collapse
|
10
|
Fahrner R, Rauchfuss F, Scheuerlein H, Settmacher U. Posttraumatic venous gas in the liver - a case report and review of the current literature. BMC Surg 2018; 18:14. [PMID: 29499671 PMCID: PMC5834843 DOI: 10.1186/s12893-018-0345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/19/2018] [Indexed: 12/02/2022] Open
Abstract
Background There are numerous causes of hepatic gas formation that range from serious pathologies to incidental findings, including mesenteric infarction, liver abscess, inflammatory bowel disease or minimally invasive hepatic interventions. Case presentation We report a case of a 50-year-old man who was admitted to the emergency room after a car accident. The clinical examination and further diagnostics revealed a craniocerebral injury with a fracture of the skull, concomitant soft tissue lesions and subarachnoidal bleeding. Furthermore, a blunt thoracic trauma with hemopneumothorax due to rib fractures was treated with a chest tube. No obvious abdominal pathology was seen. While in the operating theatre for the surgical revision of the cranial soft tissue lesions, a femoral venous catheter was inserted without any complications. A routine ultrasound of the abdomen six hours after the trauma revealed unclear hepatic gas formation. A contrast-enhanced computer tomography (CT) scan of the abdomen was performed, and the gas formation was found to be localized within the left hepatic vein. Afterwards, there was no specific treatment of the hepatic venous gas formation, as no alterations of liver function or liver enzymes were seen. The further course of the patient was uneventful regarding the gas formation in the liver, and another ultrasound two days later revealed no further gas in the liver. Conclusions The placement of a femoral venous catheter is a risk factor for gas formation in liver veins. No further treatment is needed in cases with stable liver function. To rule out serious pathologies, diagnostic findings (e.g., ultrasound, CT), clinical history and underlying diseases need to be analyzed carefully after the detection of intrahepatic gas formation. With contrast-enhanced CT, the localization of the gas and its potential causes might be detectable.
Collapse
Affiliation(s)
- René Fahrner
- University Hospital Jena, Division of General, Visceral and Vascular Surgery, Am Klinikum 1, 07740, Jena, Germany
| | - Falk Rauchfuss
- University Hospital Jena, Division of General, Visceral and Vascular Surgery, Am Klinikum 1, 07740, Jena, Germany
| | - Hubert Scheuerlein
- University Hospital Jena, Division of General, Visceral and Vascular Surgery, Am Klinikum 1, 07740, Jena, Germany.,St. Vincenz Hospital, Division of General and Visceral Surgery, Am Busdorf 2, 33098, Paderborn, Germany
| | - Utz Settmacher
- University Hospital Jena, Division of General, Visceral and Vascular Surgery, Am Klinikum 1, 07740, Jena, Germany
| |
Collapse
|
11
|
Niu DG, Li C, Fang HC. Hepatic portal venous gas associated with transcathete cardiac defibrillator implantation: A case report. Int J Surg Case Rep 2018; 44:57-61. [PMID: 29477105 PMCID: PMC5928029 DOI: 10.1016/j.ijscr.2018.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Hepatic Portal Venous Gas (HPVG) is a rare pathological condition that may be caused by iatrogenic factors. CASE REPORT A 66-year-old Chinese male patient with HPVG underwent laparotomy for chronic bowel ischemia. Transcathete cardiac defibrillator was implanted via left subclavian vein for ventricular tachycardia. DISCUSSION There are many hypotheses about how gas runs through the intestine into the mesenteric portal venous system. HPVG patients can be improved through comprehensive management. Patients with mesenteric ischemia should be observed in hospital and after discharge, and need surgical intervention if chronic bowel ischemia recurs. CONCLUSION This case proves the usefulness of comprehensive management in treating HPVG. Prognosis of HPVG should consider the pathological changes contributing to HPVG.
Collapse
Affiliation(s)
- Dong-Guang Niu
- Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Hai'er Road 59, Qingdao, Shandong, China.
| | - Chen Li
- Oncology Department, Affiliated Hospital of Qingdao University, Hai'er Road 59, Qingdao, Shandong, China.
| | - Hong-Chun Fang
- Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Hai'er Road 59, Qingdao, Shandong, China.
| |
Collapse
|
12
|
Li Z, Su Y, Wang X, Yan H, Sun M, Shu Z. Hepatic portal venous gas associated with colon cancer: A case report and literature review. Medicine (Baltimore) 2017; 96:e9352. [PMID: 29390409 PMCID: PMC5815821 DOI: 10.1097/md.0000000000009352] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Hepatic portal venous gas (HPVG) is a very rare radiological finding that occurs when gas enters the portal venous system. HGVG can be caused by various diseases, with the most common being intestinal ischemia or necrosis. While there are few reports of HPVG associated with colon cancer, we report a case of HPVG associated with advanced colon cancer. DIAGNOSIS The diagnosis of this patient was HPVG caused by colon cancer. INTERVENTIONS Left colon cancer resection, pancreatic tail resection, splenectomy, and transverse colostomy were performed. OUTCOMES The patient recovered well, and postoperative paraffin pathology confirmed that the resected tumor was colon cancer. LESSONS Abdominal computed tomography is an effective method for diagnosing and monitoring HPVG. Klebsiella pneumonia is a potential gas-producing microorganism associated with HPVG, which may be confirmed by Blood culture or drainage culture. The prognosis of HPVG is closely related to the underlying pathology. Surgery should be performed early when there are signs of intestinal ischemia, necrosis, or perforation.
Collapse
Affiliation(s)
- Zhongmin Li
- Department of Gastrointestinal Colorectal and Anal surgery
| | - Yanzhuo Su
- Department of Gastrointestinal Colorectal and Anal surgery
| | - Xueju Wang
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hongbo Yan
- Department of Gastrointestinal Colorectal and Anal surgery
| | - Mingze Sun
- Department of Gastrointestinal Colorectal and Anal surgery
| | - Zhenbo Shu
- Department of Gastrointestinal Colorectal and Anal surgery
| |
Collapse
|