Asymptomatic hepatic portal venous gas with gastric emphysema as a chronic complication of gastrostomy tube placement: a case report

Abstract

BackgroundPercutaneous endoscopic gastrostomy feeding is widely used as a route for enteral feeding for patients with impaired swallowing ability, particularly in older patients. Hepatic portal venous gas is a condition that may arise from several causes. Hepatic portal venous gas that develops after an endoscopic procedure is generally reported to be nonfatal, yet there is little information available concerning the characteristics of hepatic portal venous gas as a chronic complication of percutaneous endoscopic gastrostomy feeding.Case presentationWe experienced a case of hepatic portal venous gas that happened to be detected in an 81-year-old Japanese man with long-term percutaneous endoscopic gastrostomy use who was admitted to our hospital with aspiration pneumonia. While aspiration pneumonia was treated with antibiotics and suspension of tube feedings, he recovered from hepatic portal venous gas without any treatment.ConclusionsThe presence of a percutaneous endoscopic gastrostomy tube may have induced hepatic portal venous gas through a mechanism in which vomiting led to increased abdominal pressure and eventually gastric emphysema. This case suggests that hepatic portal venous gas without any signs of bowel ischemia or emphysematous gastritis can resolve without treatment, which is a finding that could be helpful for clinicians who deal with those supported by percutaneous endoscopic gastrostomy feeding.

Gastric emphysema secondary to severe vomiting: a comparative review of 14 cases

“…In cases where clinical presentation and radiological findings remain inconclusive, it is better to perform urgent endoscopy or diagnostic laparoscopy 12. Follow-up CT scan usually shows resolution of air in 3–4 days suggesting a favourable prognosis of gastric emphysema even with the presence of hepatic portal venous gas in uncomplicated individuals 13. In this review, initial conservative treatment was employed in most of the cases.…”

An Unusual Complication of Percutaneous Endoscopic Gastrostomy: Acute Gastric Emphysema

“…Kim et al (2020) reported that there was additional leukocytosis and an increase in C-reactive protein level at the time of patient admission. Sawano et al (2016) reported hepatic portal venous gas, leukocytosis, and elevation of C-reactive protein in addition to GE. They discontinued enteral nutrition by starting antibiotic therapy and parenteral nutrition at the time of diagnosis and reported that GE regressed without the need to remove the PEG tube.…”

Tube Feeding-Related Bowel Ischemia Presenting As Extensive Intestinal Pneumatosis Complicated With Hepatic Portal Venous Gas

“…The presence of HPVG with pneumatosis intestinalis (PI) indicates a high probability of bowel gangrene [7] and high mortality; 49% mortality with PI and 29% without PI [8]. Although mechanism is not well understood, it is associated with bowel distension, elevation of digestive tract pressure, endoscopic procedures, mucosal damage, sepsis, and gas embolization among others [4,9,10].…”