2025 Volume 67 Issue 3 Pages 220-225
A 79-year-old male patient was admitted to the hospital with hematemesis and hemorrhagic shock. Emergency endoscopy revealed an A1 stage ulcer with exposed blood vessels on the posterior wall of the cardia and lesser curvature of the upper gastric body. Hemostasis was achieved via electrostatic coagulation using hemostatic forceps. Following hemostasis, contrast-enhanced CT revealed portal venous gasemia and gastric mucosal edema. Conservative management resulted in portal venous gas resolution without intestinal necrosis. Portal venous gasemia, a potential indicator of various gastrointestinal disorders, is often associated with poor prognosis when caused by intestinal necrosis. In this case, portal venous gasemia probably occurred during electrocoagulation hemostasis for the deep gastric ulcer. Air may have entered the portal vein from an exposed blood vessel because of the increased intragastric pressure resulting from air insufflation. Although rare, portal venous gasemia can occur during gastric ulcer hemostasis; therefore, CO2 insufflation is recommended to mitigate the risk of air embolism in the lungs and cerebrovascular vessels.
