Clinical features and management of 20 patients with hepatic portal venous gas

Abstract

The present study investigated the characteristics, diagnosis, treatment and prognosis of hepatic portal venous gas (HPVG) using the data of 20 patients from the Tongji University School of Medicine Affiliated with Yangpu Hospital (Shanghai, China). The aim of the present study was to optimize the management method and improve the prognosis of patients with HPVG. A total of 20 patients were selected using a CT scan to confirm HPVG. All patients were enrolled and identified via a search engine, which examined all CT radiology reports containing the words pneumatosis and/or portal venous gas/air. Data were collected and analyzed, including sex, age, laboratory evidence, etiologies at admission, therapeutic method and in-hospital mortality. The patients consisted of 14 women (mean age, 79.1 years) and six men (mean age, 67.8 years). The results demonstrated that HPVG indicated a higher inflammatory index. The etiologies of HPVG included abdominal infection, pulmonary infection and hemorrhage, whereas the comorbidities included hypertension, diabetes, coronary disease, cerebrovascular disease and renal insufficiency. The present study determined that intestinal obstruction, acute enteritis and pulmonary infection were the main causes of HPVG. Of the 20 patients enrolled in the present study, four patients received surgery and 16 patients received conservative treatment. The overall in-hospital mortality was 25%. The present study indicated that the causes of HPVG may be closely related to inflammation and blood vessel injury. It was also determined that hemodynamic disorders of the intestinal tract and the combination of different types of infection were important contributors towards patient mortality.

Conservative treatment of hepatic portal vein gas after transarterial chemoembolization treatment for liver metastasis of postoperative esophageal cancer: a case report

“…Intestinal obstruction increased the intestinal pressure and made the gas in the intestine move into the portal vein through the superior mesenteric vein. This is the main reason for HPVG generation in this case, and the age of the patient may also be one of the important factors for HPVG generation ( 13 , 14 ). Although Xu et al ( 15 ) reported that in a case of primary liver cancer treated with multiple TACE, liver abscess caused by necrosis of liver cancer led to HPVG, the abdominal CT reexamination in our case showed that there was no massive necrosis of liver metastases and no formation of liver abscess.…”

“…Although these treatment strategies have become common methods to treat HPVG, there is no specific treatment standard to treat HPVG, and most cases still treat the cause or potential cause of HPVG ( 18 , 19 ). The clinical manifestations, imaging, and laboratory evidence of the patient determine the treatment plan for HPV ( 13 ). Koami et al ( 20 ) reported that HPVG could not be used as a predictor of emergency surgery and high mortality in the absence of significant clinical evidence of intestinal ischemia or necrosis.…”