Gas in the Portal Vein: An Emergency or Just Hot Air?

Abstract

We report the case of a 87-year-old woman admitted to our Emergency Department for mild abdominal pain associated with vomiting. An abdominal X-ray showed gas present in the portal venules of the left hepatic lobe, a finding associated with numerous surgical and medical conditions. The patient was successfully managed with conservative treatment. Isolated intrahepatic gas is a rare radiologic finding; emergency surgery should be performed only when there are signs of associated acute intestinal infarction. KeywordsHepatic portal venous gas (HPVG) • Intrahepatic pneumatosis • Emergency surgery • Intestinal ischemia • Superior mesenteric artery embolism Abbreviations WBC White blood cell Hgb Haemoglobin CRP C-reactive protein HPVG Hepatic portal venous gas AMI Acute mesenteric ischemia ED Emergency Department Case Report and EvolutionA 87-year-old woman was admitted to the ED in "Ospedale Civile Umberto I" in Lugo (Ravenna) for a single vomiting episode associated with mild abdominal pain, without fever or diarrhea. Despite her age, the patient was autonomous in her daily activities; her primary medical comorbidity was chronic atrial fibrillation treated with oral anticoagulants. On initial presentation, the patient appeared in minimal distress; abdominal examination was unremarkable. Laboratory tests showed normal WBC count and Hgb with mildly increased CRP (34 mg/dL; N.V. ≤ 10 mg/dL). An abdominal X-ray showed gas present in the portal venules of the left hepatic lobe (Fig. 1), confirmed by CT scan (Fig. 2) with * N. Zorzetti

Imaging diagnosis of a rare case of intermittent intestinal pneumatosis: A consequence of ileocecal valve clip dysfunction?

“…Blunt trauma can occur as a result of challenges experienced during surgeries or endoscopic procedures, leading to the release of gas from the digestive tract into the extraluminal area [20] . In lung diseases such as asthma, interstitial emphysema, and chronic bronchitis, alveolar rupture can cause the release of gas into the hepatic vasculature [21] .…”