1996 Volume 7 Issue 6 Pages 297-301
Hepatic portal venous gas is a rare condition that may be encountered in bowel necrosis. We report two successfully treated cases of hepatic portal venous gas associated with superior mesenteric artery (SMA) syndrome and ischemic colitis, respectively. In first case, a 28-year-old woman with progressive myoclonic seizures presented with complaints of vomiting and fever. Computed tomography showed a characteristic gas pattern in the liver and marked dilatation of the duodenum proximal to the superior mesenteric artery with a collapsed distal intestine, confirming the diagnosis of SMA syndrome with portal hepatic venous gas. Emergency laparotomy revealed an edematous stomach with phlegmon of the fundus. Fundectomy and gastrojejunostomy were performed. The second case involved a 78-year-old man who was admitted in shock. Colonofberscopy revealed mucosal necrosis and hemorrhage from the dentate line to the sigmoid colon, indicating ischemic colitis. Computed tomography showed hepatic portal venous gas and retroperitoneal emphysema around the rectum. Rectal amputation was performed. Hepatic portal venous gas is considered a serious condition with an overall mortality rate 75%, which actually reflects the outcome of coexisting septicemia. Diagnosis and treatment of the primary disease in the early stage may improve the outcome.
