Hepatic portal venous gas

Clinical significance of computed tomography findings

Sen Kuang Hou, Chii Hwa Chern, Chorng Kuang How, Jen Dar Chen, Lee Min Wang, Chen Hsen Lee

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Hepatic portal venous gas (HPVG) is a rare radiographic finding of significance. Most cases with HPVG are related to mesenteric ischemia that have been associated with extended bowel necrosis and fatal outcome. With the help of computed tomography (CT) in early diagnosis of HPVG, the clinical outcome of patients with mesenteric ischemia has improved. There has been also an increasing rate of detection of HPVG with certain nonischemic conditions. In this report, we present two cases demonstrating HPVG unrelated to mesenteric ischemia. One patient with cholangitis presented abdominal pain with local peritonitis and survived after appropriate antibiotic treatment. Laparotomy was avoided as a result of lack of CT evidence of ischemic bowel disease besides the presence of HPVG. The other case had severe enteritis. Although his CT finding preluded ischemic bowel disease, conservative treatment was implemented because of the absence of peritoneal signs or clinical toxic symptoms. Therefore, whenever HPVG is detected on CT, urgent exploratory laparotomy is only mandatory in a patient with whom intestinal ischemia or infarction is suspected on the basis of radiologic and clinical findings. On the other hand, unnecessary exploratory laparotomy should be avoided in nonischemic conditions that are usually associated with a better clinical outcome if appropriate therapy is prompted for the underlying diseases. Patients with radiographic diagnosis of HPVG should receive a detailed history review and physical examination. The patient's underlying condition should be determined to provide a solid ground for exploratory laparotomy. A flow chart is presented for facilitating the management of patients with HPVG in the ED.

Original languageEnglish
Pages (from-to)214-218
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume22
Issue number3
DOIs
Publication statusPublished - Jan 1 2004
Externally publishedYes

Fingerprint

Gases
Tomography
Liver
Laparotomy
Cholangitis
Fatal Outcome
Enteritis
Poisons
Peritonitis
Infarction
Abdominal Pain
Physical Examination
Early Diagnosis
Necrosis
Ischemia
History
Anti-Bacterial Agents
Therapeutics
Mesenteric Ischemia

Keywords

  • Computed tomography
  • Emergency department
  • Gas
  • Hepatic portal venous gas
  • Portal vein

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Hepatic portal venous gas : Clinical significance of computed tomography findings. / Hou, Sen Kuang; Chern, Chii Hwa; How, Chorng Kuang; Chen, Jen Dar; Wang, Lee Min; Lee, Chen Hsen.

In: American Journal of Emergency Medicine, Vol. 22, No. 3, 01.01.2004, p. 214-218.

Research output: Contribution to journalArticle

Hou, Sen Kuang ; Chern, Chii Hwa ; How, Chorng Kuang ; Chen, Jen Dar ; Wang, Lee Min ; Lee, Chen Hsen. / Hepatic portal venous gas : Clinical significance of computed tomography findings. In: American Journal of Emergency Medicine. 2004 ; Vol. 22, No. 3. pp. 214-218.
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