Hepatic Portal Gas in Adults

Peloponissios, Nicolas; Halkic, Nermin; Pugnale, Mauro; Jornod, Philippe; Nordback, Petter; Meyer, Alain; Gillet, M

doi:10.1001/archsurg.138.12.1367

Cited by 112 publications

(39 citation statements)

References 48 publications

(56 reference statements)

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“…In contrast, pneumatosis intestinalis (PI) is present in 73% of HPVG 7 cases, is associated with ischaemic causes and is a recognized sign of severity. 11 As reported by Peloponissios et al, 11 PI is hardly ever seen in benign causes of HPVG and could therefore be used to discriminate patients needing emergency surgery from those that can be treated conservatively. In this context, the available case reports of HPVG in blunt abdominal trauma indicate that the mortality is low and that this sign is not per se an indication for surgery.…”

Section: Discussionmentioning

confidence: 95%

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Hepatic portal venous gas in blunt abdominal trauma: A case report

Chagnon

Mosimann

2011

Injury Extra

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Section: Discussionmentioning

confidence: 95%

“…9,8,11 Intestinal air may enter venules or capillaries altered by erosion, ulceration, haematoma or necrosis. Alternatively gas may be generated by anaerobic bacteria within the gut wall.…”

Section: Discussionmentioning

confidence: 99%

Hepatic portal venous gas in blunt abdominal trauma: A case report

Chagnon

Mosimann

2011

Injury Extra

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“…Two groups should be distinguished at the time of diagnosis, those who have HPVG with associated PI, and those who have HPVG without associated PI. When associated with PI, the cause is usually an intestinal ischemia event, and in a symptomatic patient it justifies performing systematic exploratory surgery [1]. In a review of 182 cases, HPVG was most commonly due to bowel necrosis (43%), digestive tract dilatation (12%), intraperitoneal abscess (11%), ulcerative colitis (4%), gastric ulcer (4%), Crohn disease (4%), complications of endoscopic procedures (4%), intraperitoneal tumor (3%), and other (15%).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a history of biliodigestive anastomosis, endoscopic papillotomy, biliary endoprosthesis, or choledocointestinal fistula are important in the differential diagnosis [1]. …”

Section: Discussionmentioning

confidence: 99%

Hepatic Portal Venous Gas with Pneumatosis Intestinalis

Patel

2009

Gastroen Res

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Hepatic portal venous gas with pneumatosis intestinalis are radiological clues of intestinal ischemia. Prompt evaluation and a high index of clinical suspicion for the diagnosis of acute mesenteric ischemia are necessary given the high mortality of this condition. We present a case of mesenteric ischemia, radiological clues to diagnosis, and associated mechanisms. Key words: Pneumatosis intestinalis; Esenteric ischemia; Hepatic portal venous gas Case reportA 77 year old male with the past medical history of diabetes mellitus type 2 complicated by a right BKA, hypertension, hypercholesterolemia, and chronic kidney disease presents to the ED for shortness of breath and abdominal pain. Three days prior to admission he noted a sudden onset of crampy and aching pain across his lower abdomen, constant in nature, relieved somewhat with over-the-counter Maalox and Pepcid, but never completely subsiding. The same evening the pain started, he experienced nausea, but no vomiting. He had no history of biliary colic, or abdominal angina. The patient also noted increasing dyspnea, and was found sitting on the edge of his bed trying to catch his breath. He denied any recent fever or chills, hematochezia, or melena. In the ED, he was afebrile with a BP 101/50 mmHg, pulse of 93/min, and oxygen saturation of 92% on 2 liters nasal cannula, and respirations of 24/min. His cardiac exam was regular. His lungs revealed bibasilar crackles. His abdomen exam revealed an obese abdomen with some pain to deep palpation in the lower quadrants, but overall fairly benign. Bowel sounds were normoactive, and there was no hepatosplenomegaly. Rectal exam was guaic negative without any masses.Laboratory data was significant for a creatinine 3.6 mg/ dl, with normal liver function tests and coagulation tests. A V/Q scan was read as high probability for pulmonary embolism, later revised to intermediate probability. He was admitted to the hospital for treatment with IV unfractionated heparin, with the diagnosis of pulmonary embolism. His abdominal pain was never clarified on admission, but was still concerning and a CT scan of the abdomen without contrast because of renal insufficiency was ordered in the morning. Figure 1 shows portal venous air in the left hepatic lobe. Figure 2 shows mesenteric venous air throughout much of the right-sided mesenteric system and an air/blood level within the SMV. Figure 3 shows pneumatosis of the right hemicolon, findings consistent with acute mesenteric ischemia. STAT surgical consultation was obtained and after discussion with the family regarding the high operative risk of mortality versus certain sepsis and mortality without surgery, the patient and family decided to become comfort care. The patient's pain was controlled, and comfort measures were

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“…The detection of PMVG on standard radiographs, with or without PI, is predictive of bowel infarction [5]. PMVG has been associated with intestinal ischemia and necrosis in 75% of cases, ulcerative colitis in 8% of cases and intra-abdominal abscess in 6% of cases [6,7] Mortality rates exceeding 75% have been reported when PI and PMVG are seen together on plain films [7,8].…”

Section: Discussionmentioning

confidence: 99%

Pneumatosis Intestinalis and Portal Venous Gas Without Bowel Ischemia in a Patient Treated with Irinotecan and Cisplatin

et al. 2007

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Pneumatosis intestinalis and gas within the portal venous system are findings predictive of bowel ischemia. The etiologies of these alarming radiographic signs are diverse and not all causes require emergent surgical intervention. The combination of pneumatosis intestinalis, portal venous gas, and acidosis typically portends bowel ischemia and inevitable necrosis. This case report is the first description of benign pneumatosis and portal venous gas secondary to irinotecan and cisplatin.

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Hepatic Portal Gas in Adults

Cited by 112 publications

References 48 publications

Hepatic portal venous gas in blunt abdominal trauma: A case report

Hepatic portal venous gas in blunt abdominal trauma: A case report

Hepatic Portal Venous Gas with Pneumatosis Intestinalis

Pneumatosis Intestinalis and Portal Venous Gas Without Bowel Ischemia in a Patient Treated with Irinotecan and Cisplatin

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