Computed tomography demonstration of portal venous gas after hepatic artery embolization

McCarthy, Peter; Adam, Andreas; Jackson, Julia; Benjamin, I. S.; Allison, David J.

doi:10.1259/0007-1285-63-752-647

Cited by 5 publications

(4 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is also comparable with the 1% mortality rate seen in an analysis of HAI for the treatment of colorectal liver metastases in a study with a much larger sample size of 4,580 cases [26]. The fatal complication of portal venous gas has been previously observed after HAE [17], and its physiologic cause remains speculative at best, possibly resulting from the diffusion of gas from surrounding necrotic embolized tissue. In this case, the patient's postembolization course was marked by persistent nausea and abdominal pain that were refractory to standard interventions, and he would not have been dismissed from the hospital even if less stringent discharge criteria had been in place at that time.…”

Section: Discussionsupporting

confidence: 75%

See 1 more Smart Citation

Hepatic Artery Embolization for Neuroendocrine Tumors: Postprocedural Management and Complications

et al. 2012

View full text Add to dashboard Cite

After completing this course, the reader will be able to:1. Identify the components of the "postembolization syndrome": elevated liver function tests, right upper quadrant pain, nausea and vomiting, and fever.2. Distinguish the postembolization syndrome from rare complications of embolization that would merit an extended hospitalization.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTBackground. There is scant evidence to guide the management of patients after hepatic artery embolization (HAE). We examined length of stay (LOS), laboratory patterns, medication usage, morbidity, and mortality of patients hospitalized after HAE for metastatic neuroendocrine tumors. Methods. Data were abstracted retrospectively from electronic medical records on LOS, liver function tests (LFTs), i.v. antibiotics, analgesia, peak temperature, bacteremia, hepatic abscess formation, carcinoid crisis, and metastatic burden on cross-sectional imaging.

show abstract

Section: Discussionsupporting

confidence: 75%

“…vasodilators) and three groin hematomas. There was one in-hospital death associated with air in the portal venous system, a very rare complication after HAE [17] (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

Hepatic Artery Embolization for Neuroendocrine Tumors: Postprocedural Management and Complications

et al. 2012

View full text Add to dashboard Cite

show abstract

“…According to literature retrieval, the causes for HPVG include bowel ischemia, severe enteritis/intestinal perforation/intestinal fistula, intestinal obstruction, celiac infection, gastric disease, abdominal trauma and other rare causes ( 5 , 9 , 10 ). With regard to rare causes, HPVG was reported in a patient with hepatic artery embolization because of active bleeding after abdominal trauma ( 11 ). Recently, Bao reported a case of HPVG after radical cholangiocarcinectomy ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

A case report of fatal hepatic portal venous gas after transcatheter arterial chemoembolization in a patient with hepatocellular carcinoma

Xu¹,

Wang²,

Li³

2021

Transl Cancer Res TCR

View full text Add to dashboard Cite

Hepatic portal venous gas (HPVG) refers to the imaging signs formed by the abnormal accumulation of abnormal gas in the portal veins and the branches of the inner veins of the liver due to various reasons, and is usually associated with poor prognosis. HPVG is mostly caused by abdominal diseases. Herein, we reported a patient with hepatocellular carcinoma developed HPVG following transcatheter arterial chemoembolization (TACE). This patient was identified as Barcelona Clinic Liver Cancer (BCLC) stage B, and treated by five times of TACE. Gelfoam sponge was used as embolic agent in the first and last TACE treatment. After the first TACE, pneumonia occurred in the right lung, and pneumorachis with iodine oil deposition occurred in the tumor lesion in the right lobe of the liver, which was considered as hepatic abscess. After three more TACE, enhanced MRI showed significant necrosis and reduction of the lesions. After the fifth TACE, the enhancing computed tomography (CT) showed a large amount of gas in the lesions and in the portal veins, which was considered as HPVG. Although after active treatment, the patient died soon. To our knowledge, this is the first case report of a patient with hepatocellular carcinoma developed HPVG following TACE with gelfoam sponge as embolic agent.

show abstract

“…Among those demonstrating PVG following a vascular procedure, three other case reports were evaluated in addition to the patients in our study. The procedures included vascular stenting [17, 25]and therapeutic embolization of the hepatic artery [26]. All 3 of these patients demonstrated abdominal signs and/or symptoms at the time of CT. Radiographically, CT findings other than PVG were not reported in the patients who underwent stenting, whereas the embolization patient had notable liver ischemia.…”

Section: Discussionmentioning

confidence: 99%

Portal Venous Gas Detected by Computed Tomography: Is Surgery Imperative?

Iannitti¹,

Gregg²,

Mayo-Smith

et al. 2003

Dig Surg

View full text Add to dashboard Cite

Background: Portal vein gas (PVG) has historically been associated with mortality rates of 75% or higher and mandatory abdominal exploration. The following study reassesses the clinical significance of gas in the portal venous system detected by computed tomography (CT) and reevaluates the need for surgical intervention in that setting. Methods: We performed a retrospective chart review of 26 patients presenting with gas in the portal venous system as imaged by CT between August 1, 1993 and April 8, 2001. Characteristics assessed included age, sex, clinical presentation and course, additional CT findings, diagnosis, surgical versus non-surgical management, surgical findings, pathologic correlation, and mortality. Results: Of the 26 patients who had gas in the portal venous system by CT, 11 underwent surgery to determine underlying pathology. Of those who underwent surgery, 8 survived to be discharged while 3 died (73% surgical survival). The survivors presented with gastrointestinal related signs/symptoms and were found at the time of surgery to have adhesions, non-surgically treated inflammation, unclear pathology, or resectable lesions. Those who died all demonstrated marked bowel ischemia intraoperatively. Among patients who did not undergo surgery, 9 survived and 6 died (60% nonsurgical survival). Those who survived presented either asymptomatically or with pathology including acute pancreatitis, recent hypotensive episode, uncomplicated diverticulitis, unresectable colon cancer, or infectious etiology. Those who died were poor surgical candidates or status postvascular procedure. The overall survival in patients with portal venous gas by CT was 65%. Conclusion: Portal venous gas on CT is associated with a wide range of pathologies that do not necessarily warrant surgical management. Clinical presentation should be correlated with the presence of PVG and other associated CT findings prior to deciding whether surgery should be performed.

show abstract

Computed tomography demonstration of portal venous gas after hepatic artery embolization

Cited by 5 publications

References 3 publications

Hepatic Artery Embolization for Neuroendocrine Tumors: Postprocedural Management and Complications

Hepatic Artery Embolization for Neuroendocrine Tumors: Postprocedural Management and Complications

A case report of fatal hepatic portal venous gas after transcatheter arterial chemoembolization in a patient with hepatocellular carcinoma

Portal Venous Gas Detected by Computed Tomography: Is Surgery Imperative?

Contact Info

Product

Resources

About