Hepatic portal venous gas.
BACKGROUND
Hepatic portal venous gas is an unusual entity associated with a variety of abdominal catastrophes. There is usually a grave prognosis when hepatic portal venous gas is associated with ischemic bowel disease. We reported a 57-year-old man with hepatic portal venous gas associated with extensive infarction of the jejunum and a concomitant perforation at a site in the terminal ileum leading to two operations performed 24 hours apart. Progressive ischemia and infarction after the initial laparotomy resulted in massive resection of the small bowel.


METHODS
A follow-up abdominal radiography showed progressive dilatation of the small intestine and thickening of the bowel wall. Computed tomography of the abdomen showed pneumatosis intestinalis and gas collection within the intrahepatic and extrahepatic portal vein and superior mesenteric vein and free gas in the peritoneal cavity.


RESULTS
At surgery, a long segment of ischemic change of the jejunum with focal necrosis and one perforation in the terminal ileum with no relation to the ischemic area was discovered. These two areas were resected respectively, and anastomosis was performed. Extensive necrosis of the residual bowel was found on the second-look operation performed 24 hours later, and subsequent resection of involved bowel was performed, resulting in a short-bowel condition.


CONCLUSIONS
When hepatic portal venous gas associated with ischemic bowel disease is encountered, coexistence of other abdominal condition with no relation to ischemic segment should be considered.
Chiu
Hsin-Hui
HH
Department of Internal Medicine, Division of Gastroenterology, Kuo General Hospital, No 22 Sec 2, Ming-Sheng Road, Tainan, 703 Taiwan. shchiu@kgh.com
Chen
Chan-Ming
CM
Lu
Yen-Yuan
YY
Lin
Jackson Ching-Tzer
JC
Mo
Lein-Ray
LR
D004638:Emergency Treatment; D005500:Follow-Up Studies; D006801:Humans; D007238:Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D007416:Intestinal Perforation / Q000000981:diagnostic imaging* / Q000601:surgery; D007579:Jejunal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D007583:Jejunum / Q000098:blood supply*; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000000981:diagnostic imaging* / Q000601:surgery; D011168:Portal System; D011859:Radiography; D012720:Severity of Illness Index; D016896:Treatment Outcome