How to cite: Rajendran R, Hassan HAK. Portal vein gas in necrotising enterocolitis. J Neonatal Surg. 2017; 6:83. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 28-day-old boy developed abdominal distension, blood-stained gastric drainage, apnoea and hypotension. Born to G7P4A3 mother at 36w gestation, his birthweight was 1450g. He was treated in the immediate postnatal period for respiratory distress due to hyaline membrane disease with surfactant and mechanical ventilation. He was then treated for probable sepsis. On 21st day of birth he was found to have conjugated hyperbilirubinemia, intermittent pale stools and intermittent light-yellow stools, lethargy and hepatomegaly. C-reactive protein was positive. Echocardiogram showed small patent ductus arteriosus. He was given nasogastric tube-feeds of formula milk in the last 3 days. On examination, abdomen was uniformly distended and soft without erythema, oedema, tenderness or mass. Abdominal skiagram showed dilated bowel loops and portal vein gas (PVG), indirect evidence of free air and fluid in peritoneal cavity (Fig.1).
DISCUSSIONClinically and radiologically, our patient had modified Bell's stage IIIB NEC. Presence of PVG is very prominent in radiographs, but pneumoperitoneum, the hallmark of stage IIIB was, not typical. Portal vein gas represents gas distributed through fine radicles of portal vein. The bacterial translocation and production of hydrogen gas into the bowel wall cause pneumatosis intestinalis. This gas can embolize from CLINICAL IMAGE