2009, Number 2
<< Back Next >>
Ann Hepatol 2009; 8 (2)
Portal venous gas. Report of three cases
Martínez José-Luis, González-Acosta J
Language: English
References: 22
Page: 151-155
PDF size: 78.78 Kb.
Text Extraction
When portal venous gas (PVG) is found, it is usually considered an ominous sign. It is now more frequently found because of the improvement in imaging studies, mainly through computed tomography (CT). It was first related primarily to mesenteric ischemia. However, it is now identified in other conditions and the prognosis is not related to the presence in itself of PVG, but to the nature and severity of the underlying condition or disease that causes it. Next, we report three patients with portal venous gas that were seen at our surgical department. All the patients presented acute abdominal pain and during their diagnostic studies, portal venous gas was identified. Intestinal ischemia was diagnosed in two of them, who underwent an exploratory laparotomy, one of them died within 24 hours. In the other patient, the pain subsided and was treated medically and the recovery was uneventful.
In conclusion: the most important factor related to portal venous gas is the disease that caused it. The most common cause of PVG is mesenteric ischemia, so every effort should be made to rule it out, as the prognosis is related to an early diagnosis and almost all patients require surgery. Other causes had been reported and conservative treatment could be used in selected cases.
REFERENCES
Liebman P, Patten MT, Manny J, Benfield JR, Hechtman HB. Hepatic – portal venous gas in adults: etiology, pathophysiology and clinical significance. Ann Surg 1971; 187: 281-287.
Griffiths DM, Gough MH. Gas in the hepatic portal vein. Br J Surg 1986; 73: 172-176.
Najafian H, Habibi M, Reilly T. Hepatic portal vein gas: Clinical features and outcomes. Am Surg 2003; 69: 526-529.
Weinstein GE, Weiner M, Schwartz M. Portal vein gas. Am J Gastroenterol 1968; 49: 425-429.
Sebastiŕ C, Quiroga S, Espin E, Boyé R, Alvarez-Castells A, Armengol M. Portomesenteric vein gas: Pathologic mechanisms, CT Findings, and Prognosis. Radiographies 2000; 20: 1213-1224.
Chan SC, Wan YL, Cheung YC, Ng SH, Wong AMC, Ng KKl. Computed tomography findings in fatal cases of enormous hepatic portal venous gas. World J Gastroenterology 2005; 11: 2953-2955.
Hong JJ, Gadaleta D, Rossi P, Esquivel J, Davis JM. Portal Vein Gas, a Changing Clinical Entity. Arch Surg 1997; 132: 1071-175.
Monneuse O, Pilleul F, Barth X, Gruner L, Allaouchiche B, Valette PJ, Tissot E. Portal venous gas detected on computed tomography in emergency situations: surgery is still necessary. World J Surg 2007; 31: 1065-1071.
Chiu HH, Chen CM, Lu YY, Lin JCT, Mo LR. Hepatic portal venous gas. Am J Surg 2005; 189: 501-503.
Bodewes HW, Puylaert JBCM. Ultrasound in detention of portal venous gas in adults. Gastrointest Radiol 1991; 16: 35-37.
Schindera ST, Triller J, Vock P, Hoppe H. Detection of hepatic portal venous gas: its clinical impact and outcome. Emerg Radiol 2006; 12: 164-70.
Smerud MJ, Johnson CD, Stephens DH. Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases. AJR 1990; 154: 99-103.
Wiesner W, Mortele KJ, Glickman JN, Ji H, Ros PR. Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: Correlation of CT findings with severity of ischemia and clinical outcome. AJR 2001; 177: 1319-1323.
Peloponissios N, Halkic N, Pugmale M, Jornod P, Nordback P, Meyer A, Gillet M. Hepatic portal gas in adults. Arch Surg 2003; 138: 1367-1370.
Hussain A, Mahmood H, El-Hasani S. Portal vein gas in emergency surgery. World J Emerg Surg 2008; 3: 21.
Kinoshita H, Shinozaki M, Tanimura H, Umemoto Y, Sakaguchi S, Takifuji K, Kawasaki S, et al. Clinical features and management of hepatic portal venous gas. Arch Surg 2001; 136: 1410-1414.
Paran H, Epstein T, Gutman M, Feinberg MS, Zissin R. Mesenteric and Portal Vein Gas: Computerized tomography findings and clinical significance. Dig Surg 2003; 20: 127-132.
Iannitti DA, Gregg SC, Mayo-Smith WW, Tomolonis RJ, Cioffi WG, Pricolo VE. Portal venous gas detected by computed tomography: is surgery imperative? Dig Surg 2003; 20: 306-15.
Mohammed AH, Mohammed AH, Khot UP, Thomas D. Portal venous gas—case report and review of the literature. Anesthesia 2007; 62: 400-4.
Hou SK, Chern CH, How CK, Chen JD, Wang LM, Lee CH. Hepatic portal venous gas: clinical significance of computed tomography findings. Am J Emerg Med 2004; 22: 214-8.
Ito M, Horiguchi A, Miyakawa S. Pneumatosis intestinalis and hepatic portal venous gas. J Hepatobiliary Pancreatic Surg 2008; 15: 334-7.
Heemskerk J, de Hingh IH. Pneumatosis intestinalis, mesenteric venous gas and portal venous gas. Dig Surg 2008; 25: 85-6.