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Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
Portal venous gas: is it a premorbid indicator?
1Department of General Surgery, Chase Farm Hospital, Enfield, Kent, UK. obeda.kailani@doctors.org.uk
BMJ Case Reports
|June 15, 2012
Summary
A 72-year-old man experienced severe abdominal pain and vomiting, initially suspected as diverticulitis. A CT scan revealed a superior mesenteric artery thrombus causing bowel infarction, leading to a hemicolectomy and subsequent fatal intestinal hemorrhage.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Radiology
Background:
- Diverticulitis is a common cause of left iliac fossa pain, but can present insidiously.
- Superior mesenteric artery (SMA) thrombosis is a rare but catastrophic vascular emergency.
- Portal venous gas is an ominous sign, often associated with bowel ischemia.
Observation:
- A 72-year-old male presented with vague abdominal pain and vomiting, initially treated for presumed diverticulitis.
- Initial computed tomography (CT) scan was non-diagnostic.
- A repeat CT scan four days later revealed intramural gas in the colon and intrahepatic portal venous gas, alongside an SMA thrombus.
Findings:
- The SMA thrombus led to infarction of the caecum and ascending colon.
- An urgent right hemicolectomy was performed.
- Despite thrombus resolution and portal venous gas clearance, the patient succumbed to intestinal hemorrhage eight days post-surgery.
Implications:
- This case highlights the importance of considering vascular emergencies in atypical presentations of abdominal pain.
- Prompt recognition and surgical intervention are crucial in SMA thrombosis, though outcomes remain poor.
- Portal venous gas on CT necessitates urgent evaluation for bowel ischemia and potential surgical intervention.
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