Portal vein gas following air-contrast barium enema in granulomatous colitis: Report of a case

Abstract

Portal vein gas developed in a patient with granulomatous colitis following air-contrast barium enema. No symptomatology or morbidity could be attributed to the portal vein gas in this patient.

Hepatic Portal Venous Gas

“…It is hypothesized that luminal air enters the capillary veins either by an impaired epithelial barrier or by increased intraluminal pressure. Indeed, in a large number of "natural experiments," HPVG has been demonstrated in patients with mucosa disrupted by inflammatory bowel disease and intraluminal pressures increased by enema 19,20,52,68,69 or colonoscopy. 21,70 Pneumatosis intestinalis was generated experimentally in cadavers with ulcerated mucosa by application of intraluminal air pressure.…”

Hepatic Portal Gas in Adults

“…Intra-abdominal or retroperitoneal abscess [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Inflammatory bowel disease After diagnostic studies [17][18][19][20][21][22][23][24][25][26][27] Without diagnostic studies 28-30 Diverticulosis after barium enema 27,31 Biliary infection 32,33 Gastric ulcer 6,34,35 Gastric dilatation [36][37][38] Duodenal perforation 39 Blunt abdominal trauma without intestinal perforation [40][41][42] IIeus from anticholinergic adverse effects 43 Acute necrotizing pancreatitis 1 After hepatic or cardiac transplantation [44][45][46] After placement of a jejunostomy tube 47 Transgastric endoscopic ultrasound-guided biopsy 48 biliodigestive anastomosis, endoscopic papillotomy, biliary endoprosthesis, or choledocointestinal fistula are certainly of im...…”

Hepatic portal venous gas in Crohn's disease

“…8–28 Of these, 15 (58%) had prior colonoscopy, barium enema study or blunt abdominal trauma and the time frame between potential mucosal trauma and detection of HPVG was most often reported within 24 h. The number of cases that showed evidence of sepsis was 16 (62%) and a substantial number were treated with antibiotics (58%). Most of the cases were managed conservatively (73%), the majority with antibiotics, but four cases with observation alone 11 22–24. In two cases20 23 no predisposing factors were identified and it was presumed Crohn's alone was the cause.…”

“…Surgery is required for patients who have clinical or radiological evidence of free perforation or ischaemic gut30 and earlier recourse to surgery should also be considered in elderly patients 20. However, the majority of cases in Crohn's disease do not require surgery10 11 13 15 16 18 20 22–24 27 28 and those who have known risk factors for developing HPVG such as recent enteroscopy, barium enema or blunt trauma may be able to be simply observed. If symptomatic, a trial of antibiotics may be given and if there is no response only then should surgical intervention be considered.…”