Hepatic portal venous gas: A case report and analysis of 131 patients using PUBMED and MEDLINE database

Purpose Hepatic portal venous gas (HPVG) is a rare clinical finding, often caused by a severe underlying disease. In the literature as well as in clinical practice, HPVG is considered “signum malum” with a poor prognosis and bowel ischemia as the most common cause. Most studies are based on the results of computed tomography (CT) examinations. The aim of this retrospective study is to report on the prevalence, causes, and clinical course of HPVG in a monocentric cohort of abdominal ultrasound (US) investigations. Materials and Methods The US database of an academic teaching hospital was searched with specific keywords (timespan 01/2000 to 12/2020). Reports, pictures, and clinical data of all cases with HPVG were re-evaluated. Results Out of 134 804 US examinations, 8 HPVG cases were identified. There was a wide variety of underlying diseases, with mesenteric ischemia being seen in only 2 cases. 5 patients were discharged in stable condition, with 4 of them having undergone surgical treatment. 2 patients who had rejected further measures died, and one was lost to follow-up. Discussion HPVG is a rare phenomenon in clinical US. However, ultrasonographic prevalence is comparable to the prevalence in CT studies. Underlying diseases are mostly severe, and in nearly all cases an underlying cause can be found by thorough investigation. In some cases, US may even be superior to CT scans for the detection of HPVG. Despite its rarity, every sonographer should know the typical sonographic presentation of HPVG, and appropriate images should be included in US teaching modules.

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“…In 3 cases (2 with, 1 without iv contrast), air in the portal vein was not reported on CT (no. 5,6,8).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…With the improvement of people's awareness of HPVG, the treatment of HPVG is becoming more and more experienced, and its mortality is gradually decreasing (8,9). However, the pathogenesis of HPVG has not been fully clarified.…”

Section: Discussionmentioning

confidence: 99%

“…After the conservative treatment, abdominal CT was repeated on 30 December 2022, which revealed that the intestinal obstruction was relieved, and the gas accumulation in the portal vein had disappeared (Figure 3), which validated the effect of conservative treatment. Repeated blood routine revealed a white blood cell count of 4.88×10 9 /L, neutrophil level of 75.79%, neutrophil count of 3.70×10 9 /L, red blood cell count of 3.24×10 12 /L, and hemoglobin level of 100 g/L. Abdominal CT was reexamined again on 8 January 2023, showing that there was no gas accumulation in the hepatic portal vein and its branches, perihepatic effusion had disappeared, and the abdominal intestinal lumen had not expanded (Figure 4).…”

Section: Case Presentationmentioning

confidence: 99%

Conservative treatment of hepatic portal vein gas after transarterial chemoembolization treatment for liver metastasis of postoperative esophageal cancer: a case report

Wu¹,

Yang²,

Li³

et al. 2023

J Gastrointest Oncol

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Background: Hepatic portal vein gas (HPVG), which is a rare clinical manifestation, is usually considered a sign of critical illness. If the treatment is not timely, it will lead to intestinal ischemia, intestinal necrosis, and even death. There is still no consensus on whether to adopt surgical or conservative treatment for HPVG. Herein, we report a rare case of conservative treatment of HPVG after transarterial chemoembolization (TACE) treatment in a patient with liver metastasis of postoperative esophageal cancer, who received long-term enteral nutrition (EN).Case Description: A 69-year-old male patient, who had undergone surgery for esophageal cancer, needed long-term use of jejunal feeding tube implantation for enteral nutritional support due to postoperative complications. About 9 months after the operation, multiple metastases of the liver were detected. To control the progress of the disease, TACE was conducted. EN was restored on the second day after TACE, and the patient was discharged on the fifth day. On the night of discharge, the patient suddenly experienced abdominal pain, nausea, and vomiting. Abdominal computed tomography (CT) showed that the abdominal intestinal lumen was obviously dilated, liquid and gas plane shadowing was visible, and gas was visible in the portal vein and its branches. The physical examination showed that peritoneal irritation was present, and bowel sounds were active. Blood routine examination showed an increase in neutrophil and neutrophil. Symptomatic treatment, including gastrointestinal decompression, anti-infection, and parenteral nutritional support, was provided. On the third day after the presentation of HPVG, abdominal CT reexamination showed that HPVG had disappeared and the intestinal obstruction was relieved. Repeated blood routine shows a decrease in neutrophil and neutrophil.Conclusions: Elderly patients who require long-term EN support should avoid early EN support after TACE, as this can prevent intestinal obstruction and HPVG. If the patient suddenly experiences abdominal pain after TACE, CT scan should be performed in a timely manner to determine whether there is intestinal obstruction and HPVG. If the above type of patient experiences HPVG, conservative treatments such as early gastrointestinal decompression, fasting, and anti-infection treatment can be provided first without high-risk factors.

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“…Hepatic portal venous gas (HPVG) has been well documented in medical literature. The term HPVG was introduced in 1955 in infants with necrotizing enterocolitis 1,2 . HPVG used to be considered a sign that requires urgent operative intervention.…”

Section: Introductionmentioning

confidence: 99%

“…HPVG used to be considered a sign that requires urgent operative intervention. However, with the advancement in imaging technology, HPVG is now often associated with a range of benign to severe abdominal diseases, such as intestinal ischemia or necrosis, diverticulitis, inflammatory bowel disease, gastric ulcer and duodenal perforation and even benign causes such as post endoscopic procedures complication, ingestion of high concentration of hydrogen peroxide and abdominal trauma 2 …”

Section: Introductionmentioning

confidence: 99%

Hepatic veins gas bubbles in a case of emphysematous pyelonephritis

Schrader

Saunders

2023

Sonography

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Hepatic portal venous gas (HPVG) has been well documented in medical literature. The term HPVG was introduced in 1955 in infants with necrotizing enterocolitis. 1,2 HPVG used to be considered a sign that requires urgent operative intervention. However, with the advancement in imaging technology, HPVG is now often associated with a range of benign to severe abdominal diseases, such as intestinal ischemia or necrosis, diverticulitis, inflammatory bowel disease, gastric ulcer and duodenal perforation and even benign causes such as post endoscopic procedures complication, ingestion of high concentration of hydrogen peroxide and abdominal trauma. 2 The first reported case of detectable gas in hepatic veins (HV) on ultrasound was in 1989. 3 It was reported that a patient with emphysematous pyelonephritis had intravascular gas that entered the inferior vena cava through the right renal vein and extended into the HV, causing a rare but transient phenomenon. Since then, there has been a few published reports of gas in the HV. [3][4][5][6][7] We present a case study demonstrating a rare sonographic appearance of gas in the inferior vena cava (IVC) extending into the HV and right atrium, due to emphysematous pyelonephritis.

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Hepatic portal venous gas: A case report and analysis of 131 patients using PUBMED and MEDLINE database

Cited by 11 publications

References 22 publications

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

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

Conservative treatment of hepatic portal vein gas after transarterial chemoembolization treatment for liver metastasis of postoperative esophageal cancer: a case report

Hepatic veins gas bubbles in a case of emphysematous pyelonephritis

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