A CASE OF HEPATIC PORTAL VENOUS GAS WITHOUT BOWEL NECROSIS

Abstract

A 75-year-old woman was seen at the hospital because of sudden onset of abdominal pain. Tenderness and rebound tenderness were noticed on the abdomen, but muscular rigidity was lacked. Computed tomography showed massive hepatic portal venous gas in the left lobe of the liver. On emergency laparotomy, there was no necrotic bowel. A small segment of the ileum that was edematous and slightly hyperemic was found. A postoperative follow-through study of the small intestine showed thumbprinting in the ileum. We diagnosed this case as suffering from transient ileal lesion without definitive diagnosis.
Hepatic portal venous gas is a complication that is commonly observed in cases with bowel necrosis and is deemed a stigma of poor prognosis. Emergency operation is usually thought to be performed. However, hepatic portal venous gas has been also reported in cases lacking bowel necrosis like this case. Patients with hepatic portal venous gas are not always candidates for operation. In the case of hepatic portal venous gas with bowel necrosis, emergent laparotomy should be performed. If a possibility of bowel necrosis can not be ruled out, operation preceded by laparotomy should be performed. The introduction of laparoscopy may be useful not only for making the early diagnosis of the bowel necrosis but also for eliminating negative laparotomy.