2023 Volume 65 Issue 1 Pages 36-42
A 93-year-old man was diagnosed with acute obstructive cholangitis due to choledocholithiasis. Endoscopic papillary balloon dilatation was performed after ERCP. At the time of endoscopic bile duct stone removal, the basket catheter might have injured the cystic duct. The patient experienced abdominal pain 4 hours after ERCP. The following morning, a CT showed air in the cystic duct and the portal branches of the right hepatic lobe. The patient was diagnosed with hepatic portal venous gas (HPVG) and cholecystitis. An enhanced CT 1 hour later showed no signs of intestinal necrosis, and the portal venous gas decreased. Consequently, conservative treatment was performed for HPVG and percutaneous transhepatic gallbladder drainage was performed for cholecystitis. A follow-up CT 24 hours later showed marked resolution of the HPVG, and the patient recovered well. Although HPVG is the rarest complication of ERCP, it should be considered when the patient experiences post-procedural abdominal pain.
