Hepatic portal vein gas: clinical features and outcomes

Hepatic portal vein gas (HPVG) is found as branching gas extending to near the periphery of the liver. Increased utilization of CT may identify HPVG in more patients. In the past HPVG was associated with acute abdomen and high mortality. Our recent experience suggested a less morbid outcome with this entity. We wanted to identify clinical features associated with HPVG that could help us with planning care. We reviewed seven patients with CT-detected HPVG presenting over 4 months. We analyzed their histories, examinations, and laboratory data. Five of seven patients had laparotomies. Of these five one had a therapeutic resection of an ischemic bowel. All other laparotomies were nontherapeutic. Two of seven patients had no surgical intervention. One of the two refused surgery and subsequently died. The other was treated medically and recovered. Physical examination and laboratory findings were not reliable indicators of intra-abdominal catastrophe. Furthermore CT scans are inaccurate for predicting the etiology of HPVG. Close observation may be appropriate in stable patients with HPVG without other specific findings.