Portal venous gas on ultrasound

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Clinical statement: abdominal pain with elevated GGT/ALP.

Patient Data

Age: 50
Gender: Male
Modality: Ultrasound

Echogenic foci and reflectors in portal vein from gas in portal vein on colour Doppler as pathognomonic of portal venous gas.

Modality: X-ray

Small bowel obstruction with pneumatosis intestinalis and portal venous gas, findings concerning for bowel ischemia. Further evaluation with CT abdomen pelvis is recommended.

Modality: CT
  1. Findings remain consistent with small bowel obstruction with abrupt transition in bowel caliber within the right hemiabdomen at the level of the mid ileum. Overall degree of bowel distention has increased since study 3 days prior.
  2. There has been interval development of diffuse pneumatosis intestinalis beginning at the level of the ligament of Treitz and continuing throughout the jejunum and proximal ileum to the point of bowel caliber transition in the right hemiabdomen. This is highly concerning for bowel ischemia/infarction. Gas is identified within the mesenteric veins within the upper abdomen along with portal venous gas.

Case Discussion

Findings in operation: single band in ileum with complete bowel obstruction. At the site of the band was an ischemic segment of bowel. Diffuse pneumatosis intestinalis but remaining bowel appeared viable. Massive proximal distension. Blood tinged ascites.

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Case Information

rID: 41632
Case created: 11th Dec 2015
Last edited: 6th Aug 2016
Inclusion in quiz mode: Included

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