Hepatic portal venous gas: Physiopathology, etiology, prognosis and treatment

Abstract

Hepatic portal venous gas (HPVG), an ominous radiologic sign, is associated in some cases with a severe underlying abdominal disease requiring urgent operative intervention. HPVG has been reported with increasing frequency in medical literature and usually accompanies severe or lethal conditions. The diagnosis of HPVG is usually made by plain abdominal radiography, sonography, color Doppler flow imaging or computed tomography (CT) scan. Currently, the increased use of CT scan and ultrasound in the inpatient setting allows early and highly sensitive detection of such severe illnesses and also the recognition of an increasing number of benign and non-life threatening causes of HPVG. HPVG is not by itself a surgical indication and the treatment depends mainly on the underlying disease. The prognosis is related to the pathology itself and is not influenced by the presence of HPVG. Based on a review of the literature, we discuss in this paper the pathophysiology, risk factors, radiographic findings, management, and prognosis of pathologies associated with HPVG.

Pneumatosis of the intestines, colon and liver in a young cat

“…On ultrasound, an experienced radiologist may be able to identify echogenic particles within the hepatic portal vein or the non‐dependent portion of the parenchyma (Abboud et al . 2009). However, CT remains the gold‐standard and the findings mirror those on radiographs.…”

A case of hepatic portal venous gas: When time is gold

“…The increased use of computed tomography (CT) scan has allowed early and highly sensitive detection of HPVG, and in relation to a wider range of etiologies, such as ulcerative colitis (8%), intra-abdominal abscess (6%), small bowel obstruction (3%) and gastric ulcer (3%), with bowel necrosis still being the most common one (72%) [2][3][4][5][6][7][8].…”

“…The pathophysiology of HPVG is not fully understood, the factors that seem to be related with it are intestinal ischemia resulting in damage to the mucosal barrier in association with over-distension of the bowel loops and gas-forming bacterial proliferation, all of these leading to gas moving from the intestinal lumen to the mesenteric veins and flowing through it to the portal system and hepatic parenchyma [2][3][4][5].…”

“…In all cases, CT findings should be correlated with the clinical signs and with laboratory parameters to reach a high sensitivity and specificity level for intestinal necrosis [4], and in the cases where mesenteric ischemia is suspected, such as ours, rapid surgical intervention is required. Conservative management can be applied in settings where bowel ischemia is unlikely [7,9].…”

Portal pneumatosis: Sign of alert or casual discovery?

“…However, there are other causes such as inflammatory bowel disease, infectious, interventional procedures, trauma, etc, that justify this finding with better prognosis (2,3).…”