Intermittent hepatic portal vein gas complicating diverticulitis—a case report and literature review

Abstract

Based on an extensive literature search, which produced 21 observations, the etiology, symptoms, imaging features, clinical significance, treatment strategy, and outcome of HPVG because of colonic diverticulitis are evaluated: While observations with an underlying intramesocolic abscess carry a favorable prognosis, the prognosis of observations because of septic thrombophlebitis with gas forming germs is poor.

The Use of Biochemical Markers in Complicated and Uncomplicated Acute Diverticulitis

“…Past studies have also shown WBC to be higher in complicated diverticulitis (15,17,18) Bilirubin on the other hand is a marker that has had very little investigation in relation to acute diverticulitis although being shown to have high sensitivities and specificities for perforation in acute sigmoid diverticulitis. (18) Hyperbilirubinemia has been described in case reports of complicated acute diverticulitis (26,27)and has been linked to extra-hepatic bacterial infection inducing cholestasis and hepatic portal vein gas as a cause. (27,28) Our study extends these observations by showing a significant difference in bilirubin levels between uncomplicated and complicated disease.…”

“…(18) Hyperbilirubinemia has been described in case reports of complicated acute diverticulitis (26,27)and has been linked to extra-hepatic bacterial infection inducing cholestasis and hepatic portal vein gas as a cause. (27,28) Our study extends these observations by showing a significant difference in bilirubin levels between uncomplicated and complicated disease.…”

Role of Computed tomography in predicting prognosis of Hepatic portal venous gas

“…HPVG is a rare complication of diverticulitis [15] which is the second most frequently reported cause[16].Associated highly suggestive signs are colonic diverticulosis, fat standing or abscess in contact with colon wall thickening. Intra-venous antibiotic treatment is recommended even if HPVG is present on CT [9].…”

Performance assessment of the Simplified Acute Physiology Score II, the Acute Physiology and Chronic Health Evaluation II score, and the Sequential Organ Failure Assessment score in predicting the outcomes of adult patients with hepatic portal venous gas in the ED

“…However, the discovery of HPVG incidence has increased over the past 60 years due to improved diagnostic imaging and increased incidental findings detected by modern high-resolution computed tomography (CT) [2,3]. Historically, this rare radiologic finding has been associated with lethal surgical conditions [2] and high mortality rates ranging from 29% to 90% [4][5][6][7]. However, gradually over the years, some patients have survived after being treated conservatively depending on the etiology of the underlying disease [2].…”