Hepatic portal venous gas associated with acute mesenteric infarction--a case report

Hepatic portal venous gas (HPVG) is considered as an ominous prognostic sign and indicates the need for urgent surgical intervention. It has been associated with a wide variety of abdominal catastrophes, but the commonest and most serious one is infarcted bowel. This disease entity is difficult to be detected by conventional radiography. Ultrasonography and computed tomography have been reported to be more valuable methods in detecting HPVG and its cause. We report a case of HPVG associated with acute mesenteric infarction, which was detected early by ultrasonography. The computed tomography done later not only showed typical features of HPVG, but also disclosed intramural gas in the small intestine and gas in the superior mesenteric veins, which were diagnostic clues for acute mesenteric infarction. The patient survived after urgent surgery.