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Hepatic portal venous gas related to appendicitis

Keita Kouzu1, Yoshiki Kajiwara1, Suefumi Aosasa1

  • 1Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Japan.

Journal of Surgical Case Reports
|January 9, 2019
PubMed
Abstract

Insights

Hepatic portal venous gas (HPVG), a rare condition, can be caused by appendicitis. This case highlights the importance of considering appendicitis in patients presenting with HPVG and abdominal pain.

Area of Science:

  • Gastroenterology
  • Radiology
  • Critical Care Medicine

Background:

  • Hepatic portal venous gas (HPVG) is a rare radiological finding associated with high mortality.
  • The association between HPVG and appendicitis is infrequently reported.

Observation:

  • A 79-year-old male presented with acute abdominal pain, signs of peritoneal irritation, and laboratory evidence of inflammation, acidosis, and coagulopathy.
  • Computed tomography revealed HPVG, a small intestinal contrast defect, and ascites, prompting suspicion of intestinal ischemia.

Findings:

  • Laparotomy excluded intestinal ischemia but revealed a discolored, thickened appendix, confirming gangrenous appendicitis as the cause of peritonitis.
  • The patient required intensive care for septic shock post-appendectomy but recovered and was discharged.

Implications:

  • This case suggests that appendicitis can be an underlying cause of HPVG.
  • Early recognition and surgical intervention for appendicitis are crucial in patients with HPVG.

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