Brief Reports
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2005; 11(19): 2953-2955
Published online May 21, 2005. doi: 10.3748/wjg.v11.i19.2953
Computed tomography findings in fatal cases of enormous hepatic portal venous gas
Siu-Cheung Chan, Yung-Liang Wan, Yun-Chung Cheung, Shu-Hang Ng, Alex Mun-Ching Wong, Koon-Kwan Ng
Siu-Cheung Chan, Yung-Liang Wan, Yun-Chung Cheung, Shu-Hang Ng, Alex Mun-Ching Wong, Koon-Kwan Ng, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Linko Medical Center and Keelung Hospital, Taoyuan, Taiwan, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Yun-Chung Cheung, MD, First Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Lin-Kou, 5 Fu-Hsing Street, Tao Yuan Hsien, Taiwan, China. chan3015@ms27.hinet.net
Telephone: +886-3-3281200-2575 Fax: +886-3-2702023
Received: July 12, 2004
Revised: July 13, 2004
Accepted: August 31, 2004
Published online: May 21, 2005
Abstract

AIM: To assess the computed tomography (CT) findings in the patients with hepatic portal venous gas (HPVG) who presented with a short fatal clinical course in our hospital in order to demonstrate if there was any sign for prediction.

METHODS: Between January 1997 and December 2000, CT scan of the abdomen was performed on 949 patients with acute abdominal pain in our emergency department. Five patients were found having HPVG. The CT images and clinical presentations of all these five patients were reviewed.

RESULTS: In reviewing the CT findings of the cases, HPVG in bilateral hepatic lobes, abnormal gas in the superior mesenteric veins, small bowel intramural gas, and bowel distension were observed in all patients. Dry gas in multiple branches of the mesenteric vein was also revealed in all cases. All the patients expired due to irreversible septic shock within 48 h after their initial clinical presentation in emergency room. Two patients had acute pancreatitis with grade D and E Balthazar classification and they expired within 24 h due to progressing septic shock under aggressive medical treatment and life support. Two patients with underlying end stage renal disease expired within 48 h even though emergent surgical intervention was undertaken. The excited bowels revealed severe ischemic change. One patient expired only a few hours after the CT examination.

CONCLUSION: HPVG is a diagnostic clue in patients with acute abdominal conditions, and CT is the most specific diagnostic tool for its evaluation. The dry mesenteric veins are the suggestive fatal sign, especially for the deteriorating patients, with the direct effect on gastrointestinal perfusion.

Keywords: Hepatic portal vein; Intestines; Ischemia; Computed tomography