title: Asymptomatic hepatic portal venous gas with gastric emphysema as a chronic complication of gastrostomy tube placement: a case report.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy feeding is widely used as a route for enteral feeding for patients with impaired swallowing ability, particularly in older patients. Hepatic portal venous gas is a condition that may arise from several causes. Hepatic portal venous gas that develops after an endoscopic procedure is generally reported to be nonfatal, yet there is little information available concerning the characteristics of hepatic portal venous gas as a chronic complication of percutaneous endoscopic gastrostomy feeding.
  
  
  METHODS
  We experienced a case of hepatic portal venous gas that happened to be detected in an 81-year-old Japanese man with long-term percutaneous endoscopic gastrostomy use who was admitted to our hospital with aspiration pneumonia. While aspiration pneumonia was treated with antibiotics and suspension of tube feedings, he recovered from hepatic portal venous gas without any treatment.
  
  
  CONCLUSIONS
  The presence of a percutaneous endoscopic gastrostomy tube may have induced hepatic portal venous gas through a mechanism in which vomiting led to increased abdominal pressure and eventually gastric emphysema. This case suggests that hepatic portal venous gas without any signs of bowel ischemia or emphysematous gastritis can resolve without treatment, which is a finding that could be helpful for clinicians who deal with those supported by percutaneous endoscopic gastrostomy feeding.
authors.affiliation: Department of Surgery, Minamisoma Municipal General Hospital, 54-6 Takamicho 2 chome, Haramachi, Minamisoma, Fukushima, 975-0033, Japan. toyoakisawano@gmail.com.
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Sawano
authors.affiliation: Department of Home Medical Care, Minamisoma Municipal General Hospital, Fukushima, 975-0033, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nemoto
authors.affiliation: Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, University of Tokyo, Tokyo, 108-0071, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Tsubokura
authors.affiliation: Department of Research, Minamisoma Municipal General Hospital, Fukushima, 975-0033, Japan.
authors.forename: Claire
authors.initials: C
authors.lastname: Leppold
authors.affiliation: Department of Surgery, Minamisoma Municipal General Hospital, 54-6 Takamicho 2 chome, Haramachi, Minamisoma, Fukushima, 975-0033, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Ozaki
authors.affiliation: Department of Internal Medicine, Soma Central Hospital, Fukushima, 976-0016, Japan.
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Kato
authors.affiliation: Department of Gastroenterology, Minamisoma Municipal General Hospital, Fukushima, 975-0033, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kanazawa
mesh_terms: D000369:Aged, 80 and over; D004646:Emphysema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D004750:Enteral Nutrition; D005756:Gastritis / Q000000981:diagnostic imaging* / Q000628:therapy; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D011015:Pneumonia, Aspiration / Q000628:therapy*; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology*; D012131:Respiratory Insufficiency / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Complication; Emphysematous gastritis; Gastric emphysema; Percutaneous endoscopic gastrostomy; Stroke