Portal venous gas accompanied by gallbladder torsion: a case report

Abstract

Portal venous gas (PVG) generally suggests critically ill conditions such as severe bowel ischemia. We herein report a rare case of gallbladder torsion with PVG. An 88-year-old woman complained of right hypogastric pain. Ultrasonography (US) showed diffuse wall thickening of her gallbladder and mobile echogenic foci moving inside the portal venous branches. Computed tomography showed a thickened wall of the gallbladder with poor enhancement and tiny pockets of air in the portal venous branches (segments 4 and 5). There was no evidence of other visceral ischemia. She was diagnosed with necrotic cholecystitis and immediately underwent an emergency operation. We found a gangrenous gallbladder with 180° clockwise rotation along the longitudinal axis and performed cholecystectomy. We confirmed the disappearance of PVG with US after the operation. Her postoperative course was uneventful. Gallbladder diseases can produce PVG, and US might be a useful diagnostic modality to evaluate changes in PVG.

New Developments in the Ultrasonography Diagnosis of Gallbladder Diseases

“…Some authors have reported the sonographic finding of a stretched cystic duct and gallbladder neck, appearing as a conical-shaped structure composed of multiple linear echoes converging towards the tip ("cystic duct knot sign") [181][182][183]. The sonographic finding of portal venous gas associated with gallbladder ischemia in GV has been described [184].…”

Current Status and New Developments in the Ultrasonography Diagnosis of Gallbladder Diseases

“…[212][213][214] The sonographic finding of portal venous gas associated to gallbladder ischemia in GV has been described. [215] CD evaluation can detect blood flow interruption in the cystic pedicle, typically associated to the complete gallbladder torsion, and absence of vascular signals in the gallbladder wall. [210,211] A sonographic picture suggestive of GV strongly indicates emergency cholecystectomy.…”