Abstract
A 59-year-old male patient came to our clinic with the chief complaint of constipation, abdominal distention and pain. The sign of peritoneal irritation was not present. Blood test revealed mild inflammatory reaction but no acidosis in blood gas analysis. Abdominal CT study revealed gas in the portal vein that extended to the edge of the liver in tree like formation and intramular follicular gas in the cecum, but no free intraperitoneal air was present. Enhanced CT revealed homogeneous intestinal canal without image of obstruction of the mesenteric artery. Since the evidence of intestinal necrosis with perforation and acute peritonitis was lacking, pneumohemia of the portal vein due to elevated intestinal pressure caused by severe constipation was entertained and the patient was treated conservatively with hyperbaric oxygen chamber. The gas in the portal vein disappeared on the following day and the patient was cured with the conservative management. In case of intestinal necrosis or perforation an emergent laparotomy should be performed, but mild case of portal vein pneumohemia can be treated with a conservative management under strict follow up. Proper evaluation of the general condition of the patient with careful physical examination was believed to be important along with hematological and image studies.
