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Hepatic portal venous gas.
Hsin-Hui Chiu1, Chan-Ming Chen, Yen-Yuan Lu
1Department of Internal Medicine, Division of Gastroenterology, Kuo General Hospital, No 22 Sec 2, Ming-Sheng Road, Tainan, 703 Taiwan. shchiu@kgh.com
American Journal of Surgery
|April 12, 2005
Summary
Hepatic portal venous gas can signal serious abdominal issues. In this case, it accompanied both bowel infarction and a separate ileal perforation, necessitating extensive surgery and bowel resection.
Area of Science:
- Gastroenterology
- Abdominal Surgery
- Radiology
Background:
- Hepatic portal venous gas (HPVG) is a rare finding often linked to severe abdominal conditions.
- HPVG associated with ischemic bowel disease typically carries a poor prognosis.
- This case highlights a complex scenario involving HPVG, jejunal infarction, and a distinct ileal perforation.
Observation:
- A 57-year-old male presented with symptoms indicative of abdominal catastrophe.
- Radiographic and CT imaging revealed pneumatosis intestinalis, HPVG, and free peritoneal gas.
- Surgical exploration identified extensive jejunal ischemia and a separate ileal perforation.
Findings:
- The patient underwent two operations within 24 hours due to progressive ischemia.
- Initial resection of ischemic jejunum and perforated ileum was performed.
- Extensive residual bowel necrosis led to a massive small bowel resection, resulting in short-bowel syndrome.
Implications:
- HPVG in the context of ischemic bowel disease warrants consideration of concurrent, unrelated abdominal pathologies.
- Early recognition and surgical intervention are critical, though outcomes can be severe.
- This case underscores the importance of thorough intraoperative assessment for multifocal disease.