Portal and mesenteric vein gas in diverticulitis: CT findings

Computed Tomographic Evaluation of Colonic Diverticulum Complications

Cases of diverticulosis of the colon continue to increase, especially in Western countries. In these countries, two-thirds of the population older than 70 years of age are considered to experience this disease. Medical and surgical treatment for diverticulosis is begun actually for the complications of diverticulitis and lower gastrointestinal hemorrhage. The first evaluation of complicated diverticular disease is based on patient history, physical examination, and laboratory data. But all these exams and data can be inaccurate and are often questionable in the diagnoses of many features of the disease. To describe the position, severity, and presence of complications of a detected diverticulum is crucial to its appropriate treatment. The greater part of the patients have the mild disease and can be successfully cured medically. Only a small number of patients admit with acute diverticulitis and need urgent surgical intervention. Determining these patients early is crucial to morbidity and mortality reduction. Radiologic examination is important for exact evaluation of the extent of the course of the disease over the last three decades. This article aims to chart the place of the computed tomography (CT) imaging procedure in the assessment of acute complicated diverticular disease.

MDCT of acute conditions affecting the mesenteric vasculature

Acute conditions affecting the mesenteric vessels can cause abdominal pain and result in significant morbidity and mortality if not diagnosed and treated quickly. As bowel viability depends on patency of the mesenteric vessels, prompt diagnosis is essential. Helical multidetector computed tomography (MDCT) provides a rapid, widely available, non-invasive method to promptly evaluate the mesenteric arteries, veins, and abdominopelvic viscera. Given the value of MDCT in diagnosing vascular disease, it is important the radiologist understand technical and imaging findings of mesenteric vascular injury. Therefore, successful diagnosis hinges on familiarity with MDCT angiography and the extended capabilities of volume rendering and multiplanar reformation. In this review, we illustrate and describe key MDCT findings of congenital, inflammatory, traumatic, infectious, and thromboembolic conditions affecting the mesenteric vasculature in adult patients.

Extensive hepatic-portal and mesenteric venous gas due to sigmoid diverticulitis

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.

Intermittent hepatic portal vein gas complicating diverticulitis--a case report and literature review

CASE REPORT

This report describes a case of intermittent hepatic portal venous gas (HPVG) because of colonic diverticulitis in a 48-year-old man, who was successfully treated by surgery.

CONCLUSION

Based on an extensive literature search, which produced 21 observations, the etiology, symptoms, imaging features, clinical significance, treatment strategy, and outcome of HPVG because of colonic diverticulitis are evaluated: While observations with an underlying intramesocolic abscess carry a favorable prognosis, the prognosis of observations because of septic thrombophlebitis with gas forming germs is poor.

Imaging of colonic diverticular disease

Diverticular disease affects approximately two thirds of the population over the age of 70. While only a small fraction of these patients will develop diverticulitis, adequate radiological evaluation of diverticulitis and its complications is imperative in determining proper medical and surgical treatment. Clinical examination and laboratory tests alone have been found to be inaccurate in defining many aspects of the disease in up to 60% of cases. Over the past 30 years, contrast enema, computed tomography, and ultrasound have all been used extensively to diagnose the complications of diverticular disease. More recently, magnetic resonance imaging has been studied in patients with complicated diverticulitis. This article reviews the use of these different radiological modalities in diagnosing acute colonic diverticulitis and its complications.

'Benign' hepatic portal venous gas

The presence of portal venous gas within the hepatic parenchyma is usually associated with a guarded prognosis and a mortality rate approaching 75%. However, there are infrequent causes of portal venous gas not associated with dire clinical outcomes. We describe three patients who made uneventful clinical recoveries after presenting with clinical and imaging manifestations of ischaemic bowel and hepatic portal venous gas, two of which had distended but non-necrotic bowel at laparotomy.