"STOP, LOOK, and LISTEN." Hepatic Portal Venous Gas: Time for Clinical Assessment!
Pneumatosis intestinalis and portal venous gas are findings usually associated with intra-abdominal surgical catastrophes that frequently require emergent surgical intervention. Herein we present a case of a patient who presented in septic shock, with extensive portal vein gas, diffuse intestinal wall thickening, and atherosclerotic vascular insufficiency in the absence of pneumatosis intestinalis. Given his advanced age, multiple comorbidities, magnitude of the initial findings, and his dramatic clinical response to aggressive fluid resuscitation, a cognitive decision was made to continue with nonoperative management. The patient recovered uneventfully and was discharged home in a stable condition.
Department of Surgery and Department of Radiology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York.
Manuel
M
Villa
Department of Surgery and Department of Radiology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York.
Ajay N
AN
Ranade
Department of Surgery and Department of Radiology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York.
Natalia
N
Jaimes-Vanegas
Department of Surgery and Department of Radiology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York.
Heath
H
Walden
Department of Surgery and Department of Radiology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York.
Catherine A
CA
D'Agostino
Department of Surgery and Department of Radiology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York.
Jeffrey
J
Nicastro
Department of Surgery and Department of Radiology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York.
Gene F
GF
Coppa
Department of Surgery and Department of Radiology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York.
Kostas
K
Sideridis
Department of Surgery and Department of Radiology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York.
Ernesto P
EP
Molmenti
Department of Surgery and Department of Radiology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York.
Richard A
RA
Bagdonas
air; gas; liver; mesenteric ischemia; necrotizing enteritis; nonoperative treatment; pneumatosis intestinalis; portal vein; “Foot-of-the-Bed” test