A Case of Hepatic Portal Venous Gas: Hypothesis of a Transient Direct Communication between a Penetrating Antral Gastric Ulcer and Mesenteric Varices.
Hepatic portal venous gas (HPVG) is a rare radiological sign that usually signifies an acute intra-abdominal process, most commonly bowel ischemia and sepsis. Few reports described an association with underlying gastric pathologies. We report a 60-year-old patient who presented with melena and chills and was discovered to have a gastric ulcer that appeared to have penetrated into a mesenteric varix. This, in turn, likely caused development of HPVG associated with fungemia. Treatment with a proton pump inhibitor and bowel rest was sufficient to resolve symptoms and the HPVG.
Division of Internal Medicine, Steward Carney Hospital, Tufts School of Medicine, Dorchester, MA, USA.
Hassan M
0000-0002-0892-7623
HM
Ghoz
Division of Internal Medicine, Steward Carney Hospital, Tufts School of Medicine, Dorchester, MA, USA.
Shamlan M
SM
Sheikh
Division of Internal Medicine, Steward Carney Hospital, Tufts School of Medicine, Dorchester, MA, USA.
Kanika
K
Khandelwal
Division of Gastroenterology and Hepatology, Steward Carney Hospital, Tufts School of Medicine, Dorchester, MA, USA.
Joseph
J
Fiore
Division of Pulmonology and Critical Care, Steward Carney Hospital, Tufts School of Medicine, Dorchester, MA, USA.
Nicholas
0000-0002-5203-7804
N
James
Division of Gastroenterology and Hepatology, Tufts Medical Center, Tufts School of Medicine, Boston, MA, USA.
Joel
J
Weinstock