Portal venous gas: different aetiologies and their respective outcomes

Historically finding of portal venous gas (PVG) has been considered as an ominous sign and an indication for emergency surgery and reportedly has a high mortality rate. However, with the recent increasing use of imaging studies, cases of PVG associated with benign and non-life-threatening causes are increasing. The purpose of our study was to investigate the different aetiologies associated with PVG and their respective outcomes.

A consecutive series of patients with PVG was identified in our group of tertiary hospitals in Western Australia over a 10-year period. Collected data included patients' demographic data, comorbidities, blood tests results, underlying aetiology of the PVG, patients' management and their outcomes.

During the study period of 2008 to 2018, 164 patients met the inclusion criteria. Male : Female 90 versus 74. Average age was 65.6. A diverse range of underlying causes identified broadly divided into thromboembolic events (n = 70), mechanical bowel obstruction (n = 29), inflammatory conditions (n = 37) and a wide range of other pathologies (n = 28). The overall mortality was 47.5%, however, varied depending on the underlying aetiology (14.3-72.8%).

Our study demonstrates that PVG is not always a fatal sign and that mortality varies significantly depending on the aetiology. Both the patient's presenting history and the clinical findings have to be considered to recognize benign aetiology of PVG on computed tomography imaging and the treatment should be directed to the underlying disease with consideration of the high mortality rate of PVG associated with ischaemic bowel.