Hepatic Portal Venous Gas: A Potentially Lethal Sign Demanding Urgent Management

Zhou, Chenxuan; Kilpatrick, M. Duncan; Williams, Jessica Burns; Rivers, Jeannie; Miller, Thomas A.

doi:10.12659/ajcr.937197

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…HPVG, with or without the presence of PI, is a serious sign [ 9 , 10 ]. Intra-abdominal infection, intestinal ischemia, intraluminal distention, and structural alterations in the intestinal wall are the most common causes.…”

Section: Discussionmentioning

confidence: 99%

Conservative versus Surgical Treatment of Pneumatosis Intestinalis: Experience from a Multidisciplinary Center

Tran,

et al. 2024

Am J Case Rep

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Case series Patients: Male, 80-year-old • Male, 86-year-old • Male, 62-year-old Final Diagnosis: Pneumatosis intestinalis Symptoms: Abdominal pain Clinical Procedure: — Specialty: Gastroenterology and Hepatolog Objective: Rare disease Background: Pneumatosis intestinalis (PI) is an uncommon condition that is not specific to any particular disease. Currently, there is no specific clinical guideline for treating and diagnosing PI. Furthermore, there are numerous causes of PI, which makes it difficult for clinicians – internal medicine physicians as well as surgeons – to take a clinical approach to diagnosis and treatment. Case Reports: We present 3 clinical scenarios with PI. In the first patient there was a solitary image of PI, which was treated successfully with parenteral nutrition and intravenous antibiotics, and he was discharged after 5 days. The other 2 cases, which involve gas in the hepatic portal vein (HPVG), were handled in 2 distinct ways: surgically and conservatively. One needed diagnostic laparoscopy with necrotic segmentectomy and was discharged from the hospital on postoperative day 16. The last patient, received resuscitation treatment due to severe comorbidities and inability to tolerate surgery. After 3 days, abdominal CT scan revealed no signs of remaining PI. However, the patient was terminally discharged after 7 weeks of treatment due to septic shock caused by sacrococcygeal ulcer and urinary tract infection. By drawing comparisons among these 3 scenarios, we aim to highlight certain indicators for conservative treatment success. Conclusions: PI with HPVG is a sign of severe prognosis, which often requires surgical intervention. However, the decision to manage conservatively or surgically depends on the patient’s condition and other criteria such as peritonitis, free fluid in the abdominal cavity, and the presence of shock. Physicians should also weigh the benefits and risks of surgical intervention in critically ill patients.

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Section: Discussionmentioning

confidence: 99%

Conservative versus Surgical Treatment of Pneumatosis Intestinalis: Experience from a Multidisciplinary Center

Tran,

et al. 2024

Am J Case Rep

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show abstract

“…With the improvement of people's awareness of HPVG, the treatment of HPVG is becoming more and more experienced, and its mortality is gradually decreasing (8,9). However, the pathogenesis of HPVG has not been fully clarified.…”

Section: Discussionmentioning

confidence: 99%

“…With the continuous development of CT technology, high-sensitivity CT has become the preferred examination method for detecting HPVG, which gradually increases the detection rate of HPVG and enables HPVG to be treated in time ( 5 - 7 ). With the improvement of people’s awareness of HPVG, the treatment of HPVG is becoming more and more experienced, and its mortality is gradually decreasing ( 8 , 9 ). However, the pathogenesis of HPVG has not been fully clarified.…”

Section: Discussionmentioning

confidence: 99%

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

Wu¹,

Yang²,

Li³

et al. 2023

J Gastrointest Oncol

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Background: Hepatic portal vein gas (HPVG), which is a rare clinical manifestation, is usually considered a sign of critical illness. If the treatment is not timely, it will lead to intestinal ischemia, intestinal necrosis, and even death. There is still no consensus on whether to adopt surgical or conservative treatment for HPVG. Herein, we report a rare case of conservative treatment of HPVG after transarterial chemoembolization (TACE) treatment in a patient with liver metastasis of postoperative esophageal cancer, who received long-term enteral nutrition (EN).Case Description: A 69-year-old male patient, who had undergone surgery for esophageal cancer, needed long-term use of jejunal feeding tube implantation for enteral nutritional support due to postoperative complications. About 9 months after the operation, multiple metastases of the liver were detected. To control the progress of the disease, TACE was conducted. EN was restored on the second day after TACE, and the patient was discharged on the fifth day. On the night of discharge, the patient suddenly experienced abdominal pain, nausea, and vomiting. Abdominal computed tomography (CT) showed that the abdominal intestinal lumen was obviously dilated, liquid and gas plane shadowing was visible, and gas was visible in the portal vein and its branches. The physical examination showed that peritoneal irritation was present, and bowel sounds were active. Blood routine examination showed an increase in neutrophil and neutrophil. Symptomatic treatment, including gastrointestinal decompression, anti-infection, and parenteral nutritional support, was provided. On the third day after the presentation of HPVG, abdominal CT reexamination showed that HPVG had disappeared and the intestinal obstruction was relieved. Repeated blood routine shows a decrease in neutrophil and neutrophil.Conclusions: Elderly patients who require long-term EN support should avoid early EN support after TACE, as this can prevent intestinal obstruction and HPVG. If the patient suddenly experiences abdominal pain after TACE, CT scan should be performed in a timely manner to determine whether there is intestinal obstruction and HPVG. If the above type of patient experiences HPVG, conservative treatments such as early gastrointestinal decompression, fasting, and anti-infection treatment can be provided first without high-risk factors.

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Portal venous gas in a domestic shorthair cat with large cell lymphoma

Waldron,

Heo,

Vinayak

2024

Vet Record Case Reports

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Portal venous gas is defined as air within the portal venous system, whereas pneumobilia is defined as gas within the biliary tract. This report describes an 11.5‐year‐old female spayed domestic shorthair being managed for large cell lymphoma. While being hospitalised, the patient was noted to have evidence of portal venous gas on diagnostic imaging. The case study highlights common underlying causes of portal venous gas and pneumobilia in addition to diagnostic options and findings for evaluation. The most common cause of portal venous gas is bowel necrosis. Ultrasound and computed tomography scan are the most sensitive diagnostic methods in differentiation. Being familiar with the radiographic signs of and potential underlying causes of portal venous gas and pneumobilia may allow for more prompt investigations of potentially life‐threatening underlying causes. If recent surgical manipulation to the hepatobiliary/hepatoenteric system is not present and there is no history of trauma, then further diagnostic workup should be performed to evaluate for an underlying cause. Treatment of portal venous gas and pneumobilia is based on treating the suspected underlying cause.

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Hepatic Portal Venous Gas: A Potentially Lethal Sign Demanding Urgent Management

Cited by 4 publications

References 9 publications

Conservative versus Surgical Treatment of Pneumatosis Intestinalis: Experience from a Multidisciplinary Center

Conservative versus Surgical Treatment of Pneumatosis Intestinalis: Experience from a Multidisciplinary Center

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

Portal venous gas in a domestic shorthair cat with large cell lymphoma

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