Transient and rapidly resolving intrahepatic portal gas: CT findings

Hepatic portal gas (HPG) has historically been associated with high (75% or over) mortality rates related to abdominal dramatic conditions and has served as an indicator for urgent exploratory laparotomy. Over the last two decades, the greater availability and higher speed of use of CT as well as improvement in the management of critically ill patients have increased the sensitivity of imaging HPG. HPG has been found associated with a broad range of diseases, some of which are benign and do not necessarily require urgent exploratory laparotomy in the absence of signs of intra-abdominal acute condition or systemic toxicity. We present a case of transient and rapidly resolving HPG found in a 61-year-old male admitted with hypovolemic shock due to upper gastrointestinal occlusion. HPG rapidly resolved after resuscitation of the patient with intensive re-hydration and drastic decompression of the fluid-full stomach through a nasogastric tube. The physiopathology and causes of HPG are briefly reviewed and its potential clinical significance is resituated.