Portal venous gas: different aetiologies and their respective outcomes

Abstract

Background: Historically finding of portal venous gas (PVG) has been considered as an ominous sign and an indication for emergency surgery and reportedly has a high mortality rate. However, with the recent increasing use of imaging studies, cases of PVG associated with benign and non-life-threatening causes are increasing. The purpose of our study was to investigate the different aetiologies associated with PVG and their respective outcomes. Methods: A consecutive series of patients with PVG was identified in our group of tertiary hospitals in Western Australia over a 10-year period. Collected data included patients' demographic data, comorbidities, blood tests results, underlying aetiology of the PVG, patients' management and their outcomes. Results: During the study period of 2008 to 2018, 164 patients met the inclusion criteria. Male : Female 90 versus 74. Average age was 65.6. A diverse range of underlying causes identified broadly divided into thromboembolic events (n = 70), mechanical bowel obstruction (n = 29), inflammatory conditions (n = 37) and a wide range of other pathologies (n = 28). The overall mortality was 47.5%, however, varied depending on the underlying aetiology (14.3-72.8%). Conclusion: Our study demonstrates that PVG is not always a fatal sign and that mortality varies significantly depending on the aetiology. Both the patient's presenting history and the clinical findings have to be considered to recognize benign aetiology of PVG on computed tomography imaging and the treatment should be directed to the underlying disease with consideration of the high mortality rate of PVG associated with ischaemic bowel.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 767-771ANZJSurg.com

A case report of fatal hepatic portal venous gas after transcatheter arterial chemoembolization in a patient with hepatocellular carcinoma

“…Traditionally, HPVG was considered as being an indicator of poor prognosis and as being associated with a particularly high mortality rate up to 75% ( 3 ). With the development of highly advanced imaging techniques, it is gradually recognized that HPVG is not always a fatal sign, but maybe an iatrogenic and non-iatrogenic manifestation of severe abdominal diseases ( 5 ). According to literature retrieval, the causes for HPVG include bowel ischemia, severe enteritis/intestinal perforation/intestinal fistula, intestinal obstruction, celiac infection, gastric disease, abdominal trauma and other rare causes ( 5 , 9 , 10 ).…”

“…With the development of highly advanced imaging techniques, it is gradually recognized that HPVG is not always a fatal sign, but maybe an iatrogenic and non-iatrogenic manifestation of severe abdominal diseases ( 5 ). According to literature retrieval, the causes for HPVG include bowel ischemia, severe enteritis/intestinal perforation/intestinal fistula, intestinal obstruction, celiac infection, gastric disease, abdominal trauma and other rare causes ( 5 , 9 , 10 ). With regard to rare causes, HPVG was reported in a patient with hepatic artery embolization because of active bleeding after abdominal trauma ( 11 ).…”

“…Hepatic portal venous gas (HPVG) refers to the imaging signs formed by the abnormal accumulation of gas in the door veins and the branches of the inner veins of the liver due to various reasons, and is a rare imaging sign ( 3 , 4 ). HPVG was reported to occur commonly when intestinal isoemia and necrosis occur, and sepsis, abdominal infections and other non-digestive tract lesions also cause HPVG ( 5 ). Here, we reported a patient with hepatocellular carcinoma developed HPVG following TACE, resulting in a poor prognosis.…”

Portal venous gas accompanied by gallbladder torsion: a case report

“…The emergent treatments for PVG depend on the etiology [ 7 ]. Surgeons have to remove the origin of PVG to save patients, as they must detect the source of PVG.…”

A rare case of transient portal venous gas

“…While HPVG generally manifests as branching peripheral radiolucency extending to within 2 cm of the liver capsule, pneumobilia is more central in location. The nature of this distribution is in part due to the hemodynamics of portal venous flow and biliary flow, with centrifugal flow of portal venous blood to the periphery and centripetal flow of bile, with resultant peripheral or central distribution of accompanying air, respectively [1 , 2] .…”