Clinical features of patients with hepatic portal venous gas

Abstract

Background Hepatic portal venous gas (HPVG) is a rare clinical condition that is caused by a variety of underlying diseases. However, the factors that would permit accurate identification of bowel ischemia, requiring surgery, in patients with HPVG have not been fully investigated. Methods Thirty patients that had been diagnosed with HPVG using computed tomography between 2010 and 2019 were allocated to two groups on the basis of clinical and intraoperative findings: those with (Group 1; n = 12 [40%]) and without (Group 2; n = 18 [60%]) bowel ischemia. Eleven patients underwent emergency surgery, and bowel ischemia was identified in eight of these (73%). Four patients in Group 1 were diagnosed with bowel ischemia, but treated palliatively because of their general condition. We compared the characteristics and outcomes of Groups 1 and 2 and identified possible prognostic factors for bowel ischemia. Results At admission, patients in Group 1 more commonly showed the peritoneal irritation sign, had lower base excess, higher lactate, and higher C-reactive protein, and more frequently had comorbid intestinal pneumatosis. Of the eight bowel ischemia surgery patients, four (50%) died, mainly because of anastomotic leak following bowel resection and primary anastomosis (3/4, 75%). All except one patient in Group 2, who presented with aspiration pneumonia, responded better to treatment. Conclusions Earlier identification and grading of bowel ischemia according to the findings at admission should benefit patients with HPVG by reducing the incidence of unnecessary surgery and increasing the use of safer procedures, such as prophylactic stoma placement.

Hepatic Portal Venous Gas: A Potentially Lethal Sign Demanding Urgent Management

“…Having 2 or more of the following findings were suggestive of poor outcomes with nonoperative management: ascites on CT, peritoneal irritation on physical exam, and unstable vital signs indicating shock [ 11 ]. As presented in another retrospective study from 2020, other prognostic factors that have been proposed to specifically indicate bowel ischemia prompting surgical management include base excess, lactate, neutrophil-lymphocyte ratio, and CRP [ 12 ], In our patient, the CT scan on the day he became hypotensive raised a clinical suspicion for rectal stump dehiscence, making exploratory laparotomy the reasonable choice for management. Intravenous fluid resuscitation, vasopressors, and antibiotics were also indicated given his bacteremia and presumed septic status.…”

Sonographically Detected Hepatic Portal Venous Gas – Prevalence, Causes, and Clinical Implications

“…Nevertheless, multidetector CT scans are currently probably the most widely used modalities for the detection of HPVG. Accordingly, most recent studies on the frequency and management of HPVG have been performed on the basis of CT scans in radiological cohorts [14][15][16][17][18].…”

An 82-Year-Old Woman on Long-Term Hemodialysis with Ascites, Pneumatosis Coli, and 3 Episodes of Portal Venous Gas Associated with Intestinal Necrosis

“…Sever causes of portal venous gas (PVG) have been reported in adult patients, including intestinal ischemia, diverticulosis, inflammatory bowel disease, acute pancreatitis, cholangitis, and appendicitis [ 1 ]. Intestinal ischemia accounts for 40% of PVG cases, and the most common cause of intestinal ischemia is non-occlusive mesenteric ischemia (NOMI) [ 2 ]. Since the presence of intestinal necrosis reduces the survival rate of NOMI [ 3 , 4 ], a prompt and accurate diagnosis of intestinal necrosis is crucial for prognostication and consideration of surgical intervention [ 3 , 5 , 6 ].…”