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.
Department of Surgery, Teikyo University School of Medicine, Ichihara Hospital, 3426-3 Anegasaki, Ichihara, Chiba 299-0111, Japan.
Yoshitaka
Y
Furuya
Hiroshi
H
Yasuhara
Kaori
K
Ariki
Hironobu
H
Yanagie
Shuji
S
Naka
Tohru
T
Nojiri
Hiroki
H
Shinkawa
Hiroki
H
Niwa
Toshitaka
T
Nagao
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