Hepatic portal venous gas caused by blunt abdominal trauma: is it a true ominous sign of bowel necrosis? Report of a case.
A case of transient portal venous gas in the liver following blunt abdominal trauma is described. Computed tomography (CT) demonstrated hepatic portal venous gas 4 h after the injury. An exploratory laparotomy revealed segmental necrosis of the small intestine with a rupture of the bladder. Pneumatosis intestinalis was evident on the resected bowel. A histopathologic study revealed congestion and bleeding in the bowel wall and a great deal of the mucosa had been lost because of necrosis. However, neither thrombus nor atherosclerotic changes were observed in the vessels. A bacteriological examination demonstrated anaerobic bacteria from the bowel mucosa, which was most likely to produce portal venous gas. Although the present case was associated with bowel necrosis, a review of literature demonstrated that portal venous gas does not necessarily indicate bowel necrosis in trauma patients. There is another possibility that the portal venous gas was caused by a sudden increase in the intra-abdominal pressure with concomitant mucosal disruption, which thus forced intraluminal gas into the portal circulation in the blunt trauma patients.
Furuya
Yoshitaka
Y
Department of Surgery, Teikyo University School of Medicine, Ichihara Hospital, 3426-3 Anegasaki, Ichihara, Chiba 299-0111, Japan.
Yasuhara
Hiroshi
H
Ariki
Kaori
K
Yanagie
Hironobu
H
Naka
Shuji
S
Nojiri
Tohru
T
Shinkawa
Hiroki
H
Niwa
Hiroki
H
Nagao
Toshitaka
T
D000007:Abdominal Injuries / Q000150:complications*; D005740:Gases; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology* / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011027:Pneumoperitoneum / Q000150:complications / Q000209:etiology*; D011169:Portal Vein; D011379:Prognosis; D014949:Wounds, Nonpenetrating / Q000150:complications*
D005740:Gases