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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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2
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Duan XH, Duan Q, Liu JP, Le ZB, Xiao JQ, Ye R, Fang CF, Liu FE. Hepatic portal venous gas complication associated with the thoracic endovascular aortic repair for aortic dissection: a case report and literature review. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2023; 13:372-375. [PMID: 38205068 PMCID: PMC10774620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/29/2023] [Indexed: 01/12/2024]
Abstract
Aortic dissection (AD) is a serious disease with a higher mortality. The thoracic endovascular aortic repair (TEVAR) is a first line regimen for aortic dissection. Hepatic portal venous gas (HPVG) is a rare disease, and its definite mechanism is unknown. This is a rare association between the aortic and HPVG. In the present report, we present a case of thoracic aortic dissection, which was the type of Standford B by the computer tomography (CT) angiography, which implicated acute abdominal pain and abdominal distention after TEVAR and immediate abdominal CT shown hepatic portal venous gas (HPVG). The patient, who was treated with conservative treatment of gastrointestinal decompressing, fluid resuscitation, electrolyte replacement, anti-infection, anti-inflammation and anticoagulation, was recovered and discharged without abnormalities. This patient has been followed up for 5 years and has not experienced any physical discomfort related to HPVG. This is the first report that the aortic dissection patient implication with HPVG after thoracic endovascular aortic repair.
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Affiliation(s)
- Xun-Hong Duan
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Qing Duan
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Jian-Ping Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Zhi-Biao Le
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Jun-Qi Xiao
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Rong Ye
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Cui-Fu Fang
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
| | - Feng-En Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China
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Zhang Q, Meng H, Chen Y, Meng F. Bezoar as a cause of portal vein pneumatosis: a case report. J Int Med Res 2023; 51:3000605231180540. [PMID: 37377054 DOI: 10.1177/03000605231180540] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
Pneumatosis of the portal vein is considered a rare imaging sign rather than a disease. It usually occurs in patients with digestive tract diseases such as intestinal obstructive diseases, mesenteric vascular diseases, closed abdominal trauma, and liver transplantation. Because of its high mortality rate, it is also termed the "sign of death." Hawthorn contains tannic acid, and seafood is rich in calcium, iron, carbon, iodine, and other minerals and proteins. Thus, consuming both hawthorn and seafood together can result in the formation of an indigestible complex in the body, acting as the main pathogenic factor in patients with intestinal obstruction. We herein describe a patient with duodenal obstruction caused by hawthorn who developed the hepatic portal venous gas sign and was cured by nonsurgical treatment.
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Affiliation(s)
- Qing Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
| | - Heyu Meng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
| | - Yanqiu Chen
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
| | - Fanbo Meng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
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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.
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5
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Portal venous gas in a girl with chronic intestinal pseudoobstruction. Surgery 2021; 170:e17-e19. [PMID: 33902924 DOI: 10.1016/j.surg.2021.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 11/22/2022]
Abstract
Hepatic portal venous gas (HPVG) is associated with various fatal conditions requiring urgent surgical intervention. In patients with chronic intestinal pseudoobstruction (CIPO), HPVG results from intestinal dilation. CIPO is a condition that is generally not surgically remediable; however, in emergency cases, an operative approach is often considered to prevent additional complications or to restore intestinal propulsion. However, surgery in these patients is associated with high postoperative morbidity and mortality rates and frequent reoperation. Intestinal resection and adhesion formation can potentially worsen the underlying dysmotility and are associated with refractory postoperative ileus, which often requires reoperation. Here, we present a case of HPVG in a patient with chronic intestinal pseudoobstruction (CIPO), treated conservatively and discuss the management of patients with HPCG.
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Latif E, Ahmed K, Zarour A. Extensive Aeroportia, Operate or Not to Operate? A Report of a Challenging Case. Cureus 2021; 13:e13295. [PMID: 33732558 PMCID: PMC7955958 DOI: 10.7759/cureus.13295] [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] [Indexed: 11/05/2022] Open
Abstract
Aeroportia is the presence of gas in the portal vein. It is considered an ominous radiological sign with poor outcomes. Historically, it was associated with bowel necrosis, and surgery was mandated in all cases. Herein, we present a challenging case of portal venous gas and its management. An 87-year-old male patient, with multiple co-morbidities, presented with abdominal pain. The computerized tomography (CT) scan showed extensive portal venous gas without evidence of bowel ischemia. Initially, he was managed conservatively, but his clinical condition deteriorated. So, an exploratory laparotomy was performed which revealed multiple superficial splenic abscesses covering the surface of the spleen and a pale segment of jejunum with questionable viability. Splenectomy was performed and second-look laparotomy was planned to assess the small bowel viability. Second-look laparotomy revealed dusky discoloration of 30 cm jejunal segment. The affected segment was resected. The patient improved after surgery and was discharged home. In conclusion, aeroportia (portal venous gas) is a radiological entity. The clinical condition of the patient must be kept in consideration to manage the patients optimally. However, if the patient deteriorates, a high index of suspicion for mesenteric ischemia and early surgical intervention are the keys to save the patients' life.
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Affiliation(s)
- Ejaz Latif
- Surgery, Hamad Medical Corporation, Doha, QAT
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7
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Gonda M, Osuga T, Ikura Y, Hasegawa K, Kawasaki K, Nakashima T. Optimal treatment strategies for hepatic portal venous gas: A retrospective assessment. World J Gastroenterol 2020; 26:1628-1637. [PMID: 32327911 PMCID: PMC7167419 DOI: 10.3748/wjg.v26.i14.1628] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic portal venous gas (HPVG) generally indicates poor prognoses in patients with serious intestinal damage. Although surgical removal of the damaged portion is effective, some patients can recover with conservative treatments.
AIM To establish an optimal treatment strategy for HPVG, we attempted to generate computed tomography (CT)-based criteria for determining surgical indication, and explored reliable prognostic factors in non-surgical cases.
METHODS Thirty-four cases of HPVG (patients aged 34-99 years) were included. Necessity for surgery had been determined mainly by CT findings (i.e. free-air, embolism, lack of contrast enhancement of the intestinal wall, and intestinal pneumatosis). The clinical data, including treatment outcomes, were analyzed separately for the surgical cases and non-surgical cases.
RESULTS Laparotomy was performed in eight cases (surgical cases). Seven patients (87.5%) survived but one (12.5%) died. In each case, severe intestinal damage was confirmed during surgery, and the necrotic portion, if present, was removed. Non-occlusive mesenteric ischemia was the most common cause (n = 4). Twenty-six cases were treated conservatively (non-surgical cases). Surgical treatments had been required for twelve but were abandoned because of the patients’ poor general conditions. Surprisingly, however, three (25%) of the twelve inoperable patients survived. The remaining 14 of the 26 cases were diagnosed originally as being sufficiently cured by conservative treatments, and only one patient (7%) died. Comparative analyses of the fatal (n = 10) and recovery (n = 16) cases revealed that ascites, peritoneal irritation signs, and shock were significantly more frequent in the fatal cases. The mortality was 90% if two or all of these three clinical findings were detected.
CONCLUSION HPVG related to intestinal necrosis requires surgery, and our CT-based criteria are probably useful to determine the surgical indication. In non-surgical cases, ascites, peritoneal irritation signs and shock were closely associated with poor prognoses, and are applicable as predictors of patients’ prognoses.
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Affiliation(s)
- Masanori Gonda
- Department of Gastroenterology, Takatsuki General Hospital, Takatsuki 5691192, Japan
| | - Tatsuya Osuga
- Department of Gastroenterology, Takatsuki General Hospital, Takatsuki 5691192, Japan
| | - Yoshihiro Ikura
- Department of Pathology, Takatsuki General Hospital, Takatsuki 5691192, Japan
| | - Kazunori Hasegawa
- Department of Gastroenterology, Takatsuki General Hospital, Takatsuki 5691192, Japan
| | - Kentaro Kawasaki
- Department of Surgery, Takatsuki General Hospital, Takatsuki 5691192, Japan
| | - Takatoshi Nakashima
- Department of Gastroenterology, Takatsuki General Hospital, Takatsuki 5691192, Japan
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8
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Arai M, Kim S, Ishii H, Takiguchi T, Yokota H. Portal Venous Gas in Adults: Clinical Significance, Management, and Outcomes of 25 Consecutive Patients. J NIPPON MED SCH 2020; 88:88-96. [PMID: 32238741 DOI: 10.1272/jnms.jnms.2021_88-201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Portal venous gas (PVG) is a rare finding and has a grave prognosis. The most common and critical underlying pathology of PVG is bowel necrosis. However, bowel necrosis is sometimes difficult to accurately diagnose. We retrospectively analyzed data from patients that contributed to the decision to perform emergency surgery and bowel resection. METHODS Between 2009 and 2019, 25 consecutive adult patients with PVG were identified retrospectively and divided into the Operation and Non-operation groups. The Operation group was further subdivided into the Bowel resection and Non-resection groups. Clinical, laboratory, and radiographic variables were analyzed. RESULTS Conservative management was successful for 32% (8/25) of patients (Non-operation group: mortality 0%); 68% (17/25) were treated surgically (Operation group: mortality 35.3%). In the Operation group, 52.9% (9/17) underwent bowel resection (Bowel resection group: mortality 55.6%); however, bowel resection was unnecessary in 47.1% (8/17) of cases (Non-resection group: mortality 12.5%). Univariate analysis revealed significant differences between the Operation and Non-operation groups in GCS, APACHE II, abdominal distention, CRP, lactate, and CT findings of bowel dilatation, pneumatosis intestinalis, and attenuation of contrast effects of the bowel wall. However, with the exception of GCS, there was no significant difference between the Bowel resection and Non-resection groups. CONCLUSIONS Analysis of clinical, laboratory, and radiographic variables can inform decisions on conservative management. However, 47.1% of the present patients who underwent surgery for suspected bowel necrosis did not require bowel resection, suggesting that this approach alone may not be sufficient to avoid non-therapeutic laparotomy. A new approach should be developed to improve this situation.
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Affiliation(s)
- Masatoku Arai
- Department of Emergency & Critical Care Medicine, Nippon Medical School
| | - Shiei Kim
- Department of Emergency & Critical Care Medicine, Nippon Medical School
| | - Hiromoto Ishii
- Department of Emergency & Critical Care Medicine, Nippon Medical School
| | - Toru Takiguchi
- Department of Emergency & Critical Care Medicine, Nippon Medical School
| | - Hiroyuki Yokota
- Department of Emergency & Critical Care Medicine, Nippon Medical School
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Ryan JL, Dandridge LM, Andrews WS, Daniel JF, Fischer RT, Rivard DC, Wieser AB, Kane BJ, Hendrickson RJ. Conservative Management of Pneumatosis Intestinalis and Portal Venous Gas After Pediatric Liver Transplantation. Transplant Proc 2020; 52:938-942. [PMID: 32122661 DOI: 10.1016/j.transproceed.2020.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/10/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pneumatosis intestinalis (PI) is a rare pathologic finding in pediatric liver transplant (PLT) recipients. The presentation and course of PI can range from asymptomatic and clinically benign to life threatening, with no consensus regarding management of PI in children. We aim to review the clinical presentation and radiologic features of PLT recipients with PI and to report the results of conservative management. METHODS A retrospective medical chart review was conducted on PLT recipients between November 1995 and May 2016. Parameters evaluated at PI diagnosis included pneumatosis location, presence of free air or portal venous gas (PVG), symptoms, laboratory findings, and medication regimen. RESULTS PI developed in 10 of 130 PLT patients (7.7%) between 8 days and 7 years (median: 113 days) posttransplant. Five of the patients were male, and the median age was 2 years (range, 1-17 years). PI was located in 1 to 2 abdominal quadrants in 6 patients, and 3 patients had PVG. At diagnosis, all patients were on steroids and immunosuppressant medication and 6 patients had a concurrent infection. Laboratory findings were unremarkable. Symptoms were present in 7 patients. Nine patients were managed conservatively, and 1 patient received observation only. All patients had resolution of PI at a median of 7 days (range, 2-14 days). CONCLUSIONS PI can occur at any time after PLT and appears to be associated with steroid use and infectious agents. If PI/PVG is identified and the patient is clinically stable, initiation of a standard management algorithm may help treat these patients conservatively, thus avoiding surgical intervention.
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Affiliation(s)
- Jamie L Ryan
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, Missouri, USA; Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Laura M Dandridge
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, Missouri, USA; Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Walter S Andrews
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - James F Daniel
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Ryan T Fischer
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Douglas C Rivard
- Department of Radiology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Andrea B Wieser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Bartholomew J Kane
- Department of Transplantation, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
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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.
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Koizumi C, Michihata N, Matsui H, Fushimi K, Yasunaga H. In-Hospital Mortality for Hepatic Portal Venous Gas: Analysis of 1590 Patients Using a Japanese National Inpatient Database. World J Surg 2018. [PMID: 28879575 DOI: 10.1007/s00268–017–4189-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hepatic portal venous gas (HPVG) is rare but potentially serious condition. Main cause of HPVG is bowel ischemia, while detection of HPVG without bowel ischemia may have been increasing possibly due to widespread use of computed tomography. However, little is known about variation in etiologies of HPVG and mortality of HPVG with each etiology. We examined patient backgrounds, underlying diseases, and in-hospital mortality of HPVG patients using a national inpatient database. METHODS Using the Diagnosis Procedure Combination database in Japan, we identified inpatients diagnosed with HPVG from July 1, 2010 to March 31, 2015. Patients' data included age, sex, comorbidities at admission, complications after admission, body mass index, surgical procedures, medications, and discharge status. In-hospital mortality was compared between the subgroups divided by the patient backgrounds and underlying diseases. RESULTS A total of 1590 patients were identified during the study period. The mean age was 79.3 years old and the proportion of bowel ischemia was 53%. The overall in-hospital mortality was 27.3%. In-hospital mortality of HPVG with bowel ischemia, gastrointestinal tract (GIT) obstruction or dilation, GIT perforation, GIT infection, or sepsis was 26.8, 31.1, 33.3, 13.6, or 56.4%, respectively. Among patients with bowel ischemia, 32.2% patients received operation and their in-hospital mortality was 16.5%. CONCLUSIONS HPVG patients in the present study were relatively older but less likely to die than those in previous studies. Attention should be paid to the fact that mortality of HPVG without bowel ischemia was not always lower compared to that with bowel ischemia.
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Affiliation(s)
- Chie Koizumi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138510, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.
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12
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Koizumi C, Michihata N, Matsui H, Fushimi K, Yasunaga H. In-Hospital Mortality for Hepatic Portal Venous Gas: Analysis of 1590 Patients Using a Japanese National Inpatient Database. World J Surg 2017; 42:816-822. [DOI: 10.1007/s00268-017-4189-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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13
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Al Hadidi S, Tareen K. Air in the portal vein: where computed tomography saved a patient's life. Oxf Med Case Reports 2017; 2017:omx015. [PMID: 28473923 PMCID: PMC5410877 DOI: 10.1093/omcr/omx015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/22/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Samer Al Hadidi
- Hurley Medical Center, Michigan State University, Flint, MI, USA
- Correspondence address: Hurley Medical Center, Michigan State University, One Hurley Plaza, Flint, MI 48503, USA. Tel: +810-262-9682; Fax: +810-262-7245; E-mail:
| | - Kinza Tareen
- School of Human Medicine, Michigan State University, Flint, MI, USA
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14
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McNicholas DP, Kelly ME, Das JP, Bowden D, Murphy JM, Malone C. Disappearing portal venous gas in acute pancreatitis and small bowel ischemia. Radiol Case Rep 2017; 12:269-272. [PMID: 28491167 PMCID: PMC5417629 DOI: 10.1016/j.radcr.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 01/02/2017] [Indexed: 12/18/2022] Open
Abstract
We report an usual case of hepatic portal venous gas (HPVG) in the setting of acute pancreatitis and small bowel ischemia. Interestingly, the HPVG disappeared within 2 hours of the original computed tomography scan, despite the patient having small bowel ischemia. The patient had a complicated clinical course, dying 62 days postadmission. This case highlights that HPVG in setting of acute pancreatitis and small bowel ischemia has a very high morbidity and mortality, requiring early detection and aggressive surgical management.
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Affiliation(s)
- Daniel P McNicholas
- Department of Surgery, University Hospital Galway, Saolta University Healthcare Group, Newcastle Road, Galway City, Galway, Ireland
| | - Michael E Kelly
- Department of Surgery, University Hospital Galway, Saolta University Healthcare Group, Newcastle Road, Galway City, Galway, Ireland
| | - Jeeban P Das
- Department of Radiology, University Hospital Galway, Saolta University Healthcare Group, Newcastle Road, Galway City, Galway, Ireland
| | - Dermot Bowden
- Department of Surgery, University Hospital Galway, Saolta University Healthcare Group, Newcastle Road, Galway City, Galway, Ireland
| | - Joe M Murphy
- Department of Radiology, University Hospital Galway, Saolta University Healthcare Group, Newcastle Road, Galway City, Galway, Ireland
| | - Carmel Malone
- Department of Surgery, University Hospital Galway, Saolta University Healthcare Group, Newcastle Road, Galway City, Galway, Ireland
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Ginesu GC, Barmina M, Cossu ML, Feo CF, Fancellu A, Addis F, Porcu A. Conservative approach to Hepatic Portal Venous Gas: A case report. Int J Surg Case Rep 2016; 30:183-185. [PMID: 28024211 PMCID: PMC5198848 DOI: 10.1016/j.ijscr.2016.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Hepatic Portal Venous Gas (HPVG), a rare condition in which gas accumulates in the portal venous circulation, is often associated with a significant underlying pathology, such as Crohn's disease, ulcerative colitis, diverticulitis, pancreatitis, sepsis, intra-abdominal abscess, endoscopic procedures, mesenteric ischemia, abdominal trauma. PRESENTATION OF CASE Here we report a case of HPVG in an 82-year-old patient who underwent a left colectomy for stenosing tumor of the descending colon. The patient was treated conservatively, and his symptoms resolved. Follow-up computed tomography (CT) scan showed complete resolution of HPVG. DISCUSSION The mechanism underlying the passage of the gas from the intestine into the mesenteric, then portal, venous system is not fully understood. Historically, this condition has been related to acute intestinal ischemia, as a consequence of a bacterial translocation through a wall defect. CONCLUSION This case underscores the role of conservative management, highlighting how the severity of the prognosis of HPVG should be related to the underlying pathology, and not influenced by the presence of HPVG itself.
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Affiliation(s)
- G C Ginesu
- Unit of General Surgery 2, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy.
| | - M Barmina
- Unit of General Surgery 2, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy.
| | - M L Cossu
- Unit of General Surgery 2, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy.
| | - C F Feo
- Unit of General Surgery 2, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy.
| | - A Fancellu
- Unit of General Surgery 2, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy.
| | - F Addis
- Unit of General Surgery 2, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy.
| | - A Porcu
- Unit of General Surgery 2, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy.
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