Case report: Portal and systemic venous gas in a patient with perforated duodenal ulcer: CT findings

Fam, Maged Nassef Abdalla; Attia, Khaled M.; Khalil, Safaa

doi:10.3941/jrcr.v8i7.2070

Cited by 7 publications

(3 citation statements)

References 12 publications

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“…Our findings on US are compatible with previous reports in adult cases that showed that the HH sign was diagnostic for DU (6,7). In previous reports, the presence of free air and variable amounts of free fluid were significant findings indicating perforated peptic ulcers (9)(10)(11). Free air is visualized as a reverberation, having a comet-tail appearance in the ultrasound (9, 10).…”

Section: Discussionsupporting

confidence: 91%

“…Free air is visualized as a reverberation, having a comet-tail appearance in the ultrasound (9, 10). Fam et al (11) reported a case of a perforated DU with pneumoperitoneum, where air in the portal and systemic venous systems was confirmed by CT. In our study, in the patient with a perforated DU, there was no evidence of free air, but a relatively large amount of free fluid was revealed on US.…”

Section: Discussionmentioning

confidence: 95%

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Diagnostic Utility of Ultrasonography for Duodenal Ulcers in Pediatric Cases in Japan

et al. 2020

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Objective: To evaluate the diagnostic utility of wall hypertrophy of the duodenal bulb with a hyperechoic lumen, designated as the "HH sign," using ultrasound sonography (US) in pediatric duodenal ulcer (DU) patients. Study design:We performed a US for five pediatric subjects diagnosed with DU by upper gastroscopy to determine the presence of the potentially diagnostic HH sign. The sonographic images were analyzed before and after DU treatment. Computed tomography was performed in three cases and fecal occult blood test (FOBT) in all five cases.Results: Upper gastroscopy confirmed DU in all patients. While the HH sign was observed using US in four cases, with the DU located in the anterior bulb, the FOBT was positive in only one case. In these four cases, the HH sign diminished in response to treatment, as visualized by US. This was observed for both the initial as well as recurrent episodes. A mass-like region was observed in only one case, with the ulcer located in the proximity of the inferior duodenal wall. Conclusion:The HH sign is useful for the follow-up of DU, and US may be a suitable modality for the follow-up. We believe that this diagnostic marker can aid in following up a greater number of DU cases.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 95%

Diagnostic Utility of Ultrasonography for Duodenal Ulcers in Pediatric Cases in Japan

et al. 2020

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“…To be specific, firstly, infection: gas-producing bacteria, such as Clostridium perfringens , Escherichia coli and Klebsiella pneumoniae , intrude into the intestinal wall or portal vein, which have bred, thus generating gas [6, 13]. Secondly, intestinal mucosal injury and increased enteric cavity pressure: intestinal gas can act under the action of increasing intestinal pressure in the presence of intestinal mucosal injury, which can thereby enter the portal vein system through the damaged mucosa [14]. Thirdly, mixed type: HPVG is the consequence of interaction of infection with mucosal injury [15].…”

Section: Discussionmentioning

confidence: 99%

Intestinal necrosis cannot be neglected in a patient with hepatic portal vein gas combined with appendicitis: a rare case report and literature review

Chen

Fang

et al. 2019

BMC Surg

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BackgroundHepatic portal vein gas (HPVG) is a rare acute abdomen, which is not an independent disease. Meanwhile, HPVG combined with appendicitis has been rarely reported. We found only a similar report by looking for literature, but no intestinal necrosis occurred. We report a patient with HPVG, appendicitis and intestinal necrosis was reported in the current study. The patient was given frequent monitoring and had been conducted operation in time.Case presentationAn 86-year-old female with appendicitis complicated by HPVG was reported in the present study. Abdominal examination revealed rebound tenderness at the McBurney’s point. Moreover, abdominal computed tomography (CT) revealed gas in portal and mesenteric veins in addition to appendicitis. An emergency operation was planned on the appendix. However, the patient refused surgical treatment. Therefore, conservative treatment of antibiotics and frequent imaging observation was conducted for this patient. Although imaging results suggested disappeared gas in intra- and extra-hepatic portal veins, the small intestine was dilated, after conservative treatment of antibiotics. In addition, signs of diffused peritonitis could also be observed and an exploratory laparotomy was performed. Intra-operative findings had confirmed suppurated appendix, mesenteric ischemia and small intestinal necrosis.ConclusionsFrequent monitoring benefits us in observing the progress of intestinal diseases. When there exist other possible causes of HPVG such as infection, it is not easy for us to ignore the possibility of intestinal necrosis.

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Cardiovascular System Embryology and Development

Dabbagh

Amini

Abdollahifar

et al. 2023

Congenital Heart Disease in Pediatric and Adult Patients

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Case report: Portal and systemic venous gas in a patient with perforated duodenal ulcer: CT findings

Cited by 7 publications

References 12 publications

Diagnostic Utility of Ultrasonography for Duodenal Ulcers in Pediatric Cases in Japan

Diagnostic Utility of Ultrasonography for Duodenal Ulcers in Pediatric Cases in Japan

Intestinal necrosis cannot be neglected in a patient with hepatic portal vein gas combined with appendicitis: a rare case report and literature review

Cardiovascular System Embryology and Development

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