Hepatic portal venous gas (HPVG) in most cases signifies either mechanical migration of air into the portal system due to bowel ischaemia (pneumatosis intestinalis) or portal sepsis due to gas-forming organisms. Successful management of portal sepsis involves early identification of the condition, intensive resuscitation, broad-spectrum antibiotics and a laparotomy for possible bowel ischaemia. In this report, we discuss the case of a patient with pneumatosis intestinalis and HPVG after an elective laparoscopic right hemicolectomy. After an initial slow recovery, on postoperative day seven, the patient had profuse diarrhoea and confusion, and was hyponatraemic. A CT scan revealed pneumatosis intestinalis and HPVG. A laparotomy showed no obvious cause for HPVG and there was no ischaemic bowel. She was managed with intensive care, hyperbaric oxygen therapy, broad-spectrum antibiotics and total-parenteral nutrition. She has made a good recovery. This case highlights the presenting features, differential diagnoses, and management of pneumatosis intestinalis and HPVG.
Bowel obstruction due to bezoars (compaction of ingested material within the gastrointestinal tract) is a rare, but well documented occurrence. In this paper, we present two cases of potato-induced small bowel obstruction. Both patients were approximately 50 years old and had cerebral palsy and learning disabilities, respectively. They presented with abdominal pain and bilious vomiting, with no medical or surgical history. Diagnosis of small bowel obstruction was confirmed by CT prior to taking the patients to the operating theatre, where whole potatoes were found to be obstructing each patient's bowel lumen. Both patients underwent laparotomy with enterotomy and removal of the potato. They both made a good recovery. Through a literature review of bezoar-induced bowel obstruction, these cases highlight important diagnostic and management principles.
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