Computed tomography findings in fatal cases of enormous hepatic portal venous gas.
OBJECTIVE
To assess the computed tomography (CT) findings in the patients with hepatic portal venous gas (HPVG) who presented with a short fatal clinical course in our hospital in order to demonstrate if there was any sign for prediction.


METHODS
Between January 1997 and December 2000, CT scan of the abdomen was performed on 949 patients with acute abdominal pain in our emergency department. Five patients were found having HPVG. The CT images and clinical presentations of all these five patients were reviewed.


RESULTS
In reviewing the CT findings of the cases, HPVG in bilateral hepatic lobes, abnormal gas in the superior mesenteric veins, small bowel intramural gas, and bowel distension were observed in all patients. Dry gas in multiple branches of the mesenteric vein was also revealed in all cases. All the patients expired due to irreversible septic shock within 48 h after their initial clinical presentation in emergency room. Two patients had acute pancreatitis with grade D and E Balthazar classification and they expired within 24 h due to progressing septic shock under aggressive medical treatment and life support. Two patients with underlying end stage renal disease expired within 48 h even though emergent surgical intervention was undertaken. The excited bowels revealed severe ischemic change. One patient expired only a few hours after the CT examination.


CONCLUSIONS
HPVG is a diagnostic clue in patients with acute abdominal conditions, and CT is the most specific diagnostic tool for its evaluation. The dry mesenteric veins are the suggestive fatal sign, especially for the deteriorating patients, with the direct effect on gastrointestinal perfusion.
Chan
Siu-Cheung
SC
First Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Lin-Kou, 5 Fu-Hsing Street, Tao Yuan Hsien, Taiwan, China.
Wan
Yung-Liang
YL
Cheung
Yun-Chung
YC
Ng
Shu-Hang
SH
Wong
Alex-Mun-Ching
AM
Ng
Koon-Kwan
KK
D000006:Abdomen, Acute / Q000000981:diagnostic imaging* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D017809:Fatal Outcome; D005260:Female; D005740:Gases; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging*; D013152:Splanchnic Circulation; D014057:Tomography, X-Ray Computed; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000401:mortality
D005740:Gases