Gas in the Portal Venous System -A Report of 4 Cases

Yoshikazu Fukuda, Kazuma Tsukioka, Fumihiro Kawasaki, Yoshio Matsuo, Takahisa Yoshimura

Osaka City General Hospital, Emergency and Critical Care Medical Center

Gas in the portal venous system (GPVS) can rarely be detected in various digestive diseases. And GPVS is commonly accepted as one of the signs of poor prognosis. We had four cases of GPVS revealed on admission in the 10 months after the opening of our hospital. All the patients were saved by emergency laparotomy. The ages of the one male and three female patients ranged from 20 to 75 years. Two patients were in shock when they arrived at our hospital. The definitive diagnoses were necrotizing enteritis of the ileo-cecal region, obstructive jejuno-colitis due to fecal impaction, strangulated ileus and non-occlusive mesenteric infarction. In all cases, GPVS was associated with bowel necrosis and GPVS was noted on the preoperative CT scan (Cases 1 & 4 in the intrahepatic portal vein, Cases 2 & 3 in the mesenteric vein). The microscopic findings of case 4 showed pneumatosis cystoides intestinalis. GPVS clearly suggests severe bowel necrosis, so a laparotomy should be performed as early as possible in such cases. An abdominal CT scan is always extremely useful for detecting GPVS. Therefore, by adjusting the window level we have to try to show GPVS on the CT scan in case of acute abdomen. Finally, it is also essential to keep GPVS in mind, especially when the patient is suspected of having bowel necrosis.

Key words
gas in the portal venous system, bowel necrosis, early laparotonry

Reprint requests
Yoshikazu Fukuda Osaka City General Hospital, Emergency and Critical Care Medical Center
2-13-22 Miyakojima-Hondouri, Miyakojima-ku, Osaka, 534 JAPAN

Accepted
February 14, 1996

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