Pneumatosis intestinalis and hepatic portal venous gas

Abstract

We report two cases of pneumatosis intestinalis and hepatic portal venous gas. The first case was in a 67-year-old woman who complained of strong right lower abdominal pain and high fever on the twelfth day after pancreatoduodenectomy (PD) with portal vein (PV) resection. Abdominal X-ray and computed tomography showed hepatic portal venous gas and pneumatosis intestinalis. The emergency laparotomy performed disclosed extensive necrosis of the bowel from the jejunum to the ascending colon. All necrotic parts of the bowel were resected and a jejunostomy was performed. The residual intact small intestine was 30 cm in length. Her postoperative course was stable. This is a rare complication after PD and cannot be cured by any other treatment but surgery. The second case was in a 45-year-old woman with the chief complaint of abdominal pain and constipation. She had a past history of chronic toluene inhalation. Abdominal X-ray and computed tomography also showed hepatic portal venous gas and pneumatosis intestinalis, as well as free air, but no physical examination or laboratory test results supported a diagnosis of bowel necrosis. Hyperbaric oxygen (HBO) therapy effectively controlled the symptoms and signs.

Radiography and ultrasonography of pneumatosis intestinalis in a cat

“…Portal venous gas has been frequently reported as a concurrent finding when bowel wall ischemia and necrosis are present in human reports and has been suggested in the veterinary literature . Portal venous gas has also been associated with hydrogen peroxide ingestion in a dog .…”

Aeroportia and acute abdominal pain: ischemic bowel necrosis

“…Aeroportia is more suggestive (although non-pathognomonic) of transmural necrosis than pneumatosis intestinalis, and it carries a worse prognosis [3]. These features cannot guide the search for the cause of ischemia: they may appear with embolic, thrombotic, or low cardiac outflow ischemia, as well as with other diseases [1,4]. Morris et al have recently reviewed 97 patients with pneumatosis intestinalis on the CT scan: approximately one half of patients with pneumatosis intestinalis could be successfully managed non-operatively, but the association of aeroportia conferred a high mortality rate [3].…”

Symptomatic pneumatosis intestinalis (including portal venous gas) after laparoscopic total colectomy

“…Much prior experience has indicated that the finding of PI (most especially in association with PVG [3] ) on postoperative imaging in an unwell patient is an ominous sign that should trigger re-exploratory surgery, likely laparotomy [4,5] . However, in other settings, PI is known to have a benign course and the same appearances can be seen in association with steroid or chemotherapy usage, trauma and inflammatory conditions [6] .…”