Portal venous gas: benign aetiology

Case contributed by Dr René Pfleger

Presentation

Abdominal pain. Unwell. Tachycardia. Dehydration. Electrolyte derangement. Low eGFR.

Patient Data

Age: Septuagenarian
Gender: Male
Modality: CT

Hepatic portal venous gas in both lobes is noted along with portal venous gas in central portal vein. Intestinal pneumatosis worrisome for transmural necrosis is also seen. There is high grade arteriosclerosis involving the splanchnic and renal arteries. A biventricular pacemaker is also noted. There is colonic diverticulosis without evidence of diverticulitis.

No evidence of pneumoperitoneum, interloop or gross ascitess ascites nor bowel obstruction. 

Overall findings are worrisome for mesenteric ischemia, especially taking clinical presentation into account. 

Modality: Annotated image

Case Discussion

Patient went on the the theatre, where exploratory laparoscopy was performed. All intestinal segments were vital. Patient was diagnosed with severe gastroenteritis both clinically and by stool analysis.

Hepatic portal venous gas, when seen on conventional x-rays, is often associated with a poor prognosis. However, with the advent of cross-sectional imagining, the detection of hepatic portal venous gas has improved and several benign causes have been reported in literature 1-2,4

Although a repeat imaging study in stable patients has been proposed, most authors postulate exploratory laparotomy as standard of care when dealing with symptomatic patients, in order to rule out sinister pathology such as mesenteric ischemia. 

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Case Information

rID: 32228
Case created: 20th Nov 2014
Last edited: 3rd Sep 2015
Inclusion in quiz mode: Included

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