Hepatic Portal Venous Gas

Nelson, Aaron; Millington, Timothy M.; Sahani, Dushyant V.; Chung, Raymond T.; Bauer, Christian; Hertl, Martin; Warshaw, Andrew L.; Conrad, Claudius

doi:10.1001/archsurg.2009.88

Cited by 191 publications

(104 citation statements)

References 61 publications

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“…This latter result is likely a random finding and clinically insignificant, since PI and PMVG represent progressive steps in a single pathophysiological process. Gas progressively ascends from the bowel wall to the liver, extending through the arcade veins, the segmental veins, the superior mesenteric vein, and finally into the extra- and intrahepatic portal veins [1, 7, 19, 30]. Nevertheless, although significantly correlated with ischemia in our study, PMVG may result from various other conditions, as reported by Hussain et al [7], namely the increase of luminal pressure in case of obstructive and non-obstructive bowel dilatation as well as bacterial contamination of the portomesenteric venous system from the digestive tract.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of pneumatosis intestinalis – correlation of MDCT-findings with treatment and outcome

et al. 2016

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ObjectivesTo evaluate the clinical significance of pneumatosis intestinalis (PI) including the influence on treatment and outcome.Method and MaterialsTwo radiologists jointly reviewed MDCT-examinations of 149 consecutive emergency patients (53 women, mean age 64, range 21-95) with PI of the stomach (n = 4), small (n = 68) and/or large bowel (n = 96). PI extension, distribution and possibly associated porto-mesenteric venous gas (PMVG) were correlated with other MDCT-findings, risk factors, clinical management, laboratory, histopathology, final diagnosis and outcome.ResultsThe most frequent cause of PI was intestinal ischemia (n = 80,53.7 %), followed by infection (n = 18,12.1 %), obstructive (n = 12,8.1 %) and non-obstructive (n = 10,6.7 %) bowel dilatation, unknown aetiologies (n = 8,5.4 %), drugs (n = 8,5.4 %), inflammation (n = 7,4.7 %), and others (n = 6,4 %). Neither PI distribution nor extension significantly correlated with underlying ischemia. Overall mortality was 41.6 % (n = 62), mostly related to intestinal ischemia (p = 0.003). Associated PMVG significantly correlated with underlying ischemia (p = 0.009), as did the anatomical distribution of PMVG (p = 0.015). Decreased mural contrast-enhancement was the only other MDCT-feature significantly associated with ischemia (p p < 0.001). Elevated white blood count significantly correlated with ischemia (p = 0.03).ConclusionIn emergency patients, ischemia remains the most common aetiology of PI, showing the highest mortality. PI with associated PMVG is an alerting sign. PI together with decreased mural contrast-enhancement indicates underlying ischemia.Key Points• In emergency patients, PI may be caused by various disorders.• Intestinal ischemia remains the most common cause of PI in acute situations.• PI associated with decreased mural contrast-enhancement indicates acute intestinal ischemia.• PI associated with PMVG should alert the radiologist to possible underlying ischemia.

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Section: Discussionmentioning

confidence: 99%

Clinical significance of pneumatosis intestinalis – correlation of MDCT-findings with treatment and outcome

et al. 2016

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“…HPVG was recognized to be fatal in the 1980s, yet recent increases in cases have demonstrated that non-symptomatic HPVG is not necessarily fatal [13]. In the present case, there were no acute abdominal symptoms on physical examination, and a blood test showed pH 7.445, base excess 1.9 mmol/L, and lactate dehydrogenase 224 IU/l.…”

Section: Discussionmentioning

confidence: 53%

“…The mortality rate for HPVG with necrotizing colitis is approximately 75 % [11, 12], whereas the mortality rate for HPVG without necrotizing colitis is not as high, highlighting the importance of distinguishing whether cases of HPVG may be fatal or nonfatal particularly by ruling out necrotizing colitis [13]. In terms of HPVG as a PEG-related complication, only cases of HPVG occurring immediately following PEG insertion have been reported to date [5, 6].…”

Section: Introductionmentioning

confidence: 99%

Asymptomatic hepatic portal venous gas with gastric emphysema as a chronic complication of gastrostomy tube placement: a case report

Sawano¹,

Nemoto²,

Tsubokura

et al. 2016

J Med Case Reports

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BackgroundPercutaneous endoscopic gastrostomy feeding is widely used as a route for enteral feeding for patients with impaired swallowing ability, particularly in older patients. Hepatic portal venous gas is a condition that may arise from several causes. Hepatic portal venous gas that develops after an endoscopic procedure is generally reported to be nonfatal, yet there is little information available concerning the characteristics of hepatic portal venous gas as a chronic complication of percutaneous endoscopic gastrostomy feeding.Case presentationWe experienced a case of hepatic portal venous gas that happened to be detected in an 81-year-old Japanese man with long-term percutaneous endoscopic gastrostomy use who was admitted to our hospital with aspiration pneumonia. While aspiration pneumonia was treated with antibiotics and suspension of tube feedings, he recovered from hepatic portal venous gas without any treatment.ConclusionsThe presence of a percutaneous endoscopic gastrostomy tube may have induced hepatic portal venous gas through a mechanism in which vomiting led to increased abdominal pressure and eventually gastric emphysema. This case suggests that hepatic portal venous gas without any signs of bowel ischemia or emphysematous gastritis can resolve without treatment, which is a finding that could be helpful for clinicians who deal with those supported by percutaneous endoscopic gastrostomy feeding.

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“…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. 10 Our patient showed no PI and was indeed operated for haemodynamic instability. The complete clearance of his HPVG within a week strengthens the view that it was a benign occurrence.…”

Section: Discussionmentioning

confidence: 60%