Three Cases of Portal Venous Gas Associated with Acute Abdomen

Yoshihiko Sakamoto, Hiroshi Fukui, Yasutaka Tsurunaga, Toshiaki Shiogama, Akimasa Mizutani, Masahiro Fujimoto

Department of Surgery, Nagasaki Memorial Hospital

Portal venous gas (PVG) seems to occur in a variety of digestive diseases, and has a grave prognosis. We have had three cases of PVG in adults associated with acute abdomen during an eight-month period. Case 1, a l9-year-old man, was diagnosed as having panperitonitis due to perforation of acute appendicitis. Abdominal computed tomography (CT) demonstrated a characteristic gas pattern in the peripheral region of the liver, indicating PVG. In case 2, a 69-year-old woman with ischemic colitis, peripheral distribution of gas within the liver was shown in the medial segment. Case 3, a 74-year-old woman, was diagnosed as having hemorrhagic necrosis of the ileum which resulted from strangulation. She underwent ultrasonography (US), which showed echogenic particle in the right lobe of the liver. CT scan and US of the liver may be better for the detection of PVG than plain X-ray examination. We suggest that the prognosis of these cases in which PVG disappeared in the early postoperative period is good. In this study, 25 cases reported in Japan were reviewed. The overall mortality rate was 56.0%. The prognosis was poor in cases of bowel necrosis or extrahepatic portal vein.

Key words
portal venous gas with acute abdomen

Reprint requests
Yoshihiko Sakamoto Second Department of Surgery, Nagasaki University School of Medicine
7-1 Sakamoto-machi, Nagasaki, 852 JAPAN

Accepted
January 13, 1993

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