Hepatic Portal Venous Gas : Report of Two Cases

Abstract

We report on two cases of hepatic portal venous gas (HPVG). Case 1 was a 78-year-old male who was referred to our hospital after a fall. Physical examination of the abdomen revealed generalized tenderness, but there was no peritoneal sign. An abdominal computed tomographic (CT) scan showed HPVG and signs of segmental ischemia in the small bowel. We performed an exploratory laparotomy and resected 50 cm of nonviable ileum. The patient's condition deteriorated postoperatively in the intensive care unit (ICU) and he died of multi-organ failure on hospital day 40. Case 2 was a 55 year-old-male who presented at our hospital with appetite loss and abdominal distension. Abdominal X-ray revealed a dilated small bowel. An abdominal CT scan lead to the diagnosis of HPVG and pneumatosis intestinalis (PI). It also demonstrated the presence of gas inside the inferior vena cava (IVC). An exploratory laparotomy showed small bowel volvulus without any sign of necrosis. Although detorsion of the volvulus was successfully performed, the patient's postoperative course was complicated by bacterial pneumonia and he died on hospital day 65. The surgical indication of HPVG still remains unclear. From our literature review, HPVG on abdominal X-ray and HPVG accompanied by PI represent a high risk of bowel ischemia, in which cases surgical intervention should be considered.