Pneumatosis intestinalis and hepatic portal venous gas in Crohn's disease

BACKGROUND: Hepatic portal venous gas (HPVG) is a rare condition that occurs when intraluminal gas and/or gas produced by intestinal bacteria enters the portal venous circulation. The most common precipitating factors include ischemia, intra-abdominal abscesses and inflammatory bowel disease. However, HPVG has recently been recognized as a rare complication of endoscopic and radiological procedures. Earlier studies advised immediate surgical intervention, but according to current recommendations, in some settings, HPVG can be managed conservatively. The present study reports two cases of HPVG; one that occurred following colonoscopy in a patient with severe Crohn’s disease and one in a patient with graft-versus-host disease.METHODS: The epidemiology, pathogenesis, diagnosis and management of HPVG are reviewed. Two case reports are presented, followed by the development of a management algorithm.RESULTS: Of the two patients that developed HPVG, one was an outpatient undergoing a colonoscopy for assessment of Crohn’s disease activity and the other was an inpatient with graft-versus-host disease. Once the diagnosis of HPVG was made, both patients were managed conservatively with antibiotic therapy and management of their underlying disease.CONCLUSIONS: HPVG can occur in the setting of severe gastrointestinal disease states and following endoscopic procedures. It is critical that gastroenterologists are aware of the differential diagnosis, pathogenesis, diagnostic approach and management of HPVG.

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First presentation of Crohn’s disease complicated with hepatic portal venous gas and pylephlebitis

South African Journal of Radiology ◽

10.4102/sajr.v21i1.1212 ◽

2017 ◽

Vol 21 (1) ◽

Author(s):

Beom Jun Lee ◽

Ahmed O. A. Krim ◽

Paul Samson

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Surgical Complication ◽

Abdominal Sepsis ◽

Surgical Patient ◽

Published Data ◽

Hepatic Portal Venous Gas ◽

Radiological Findings ◽

Portal Venous Gas ◽

Hepatic Portal

The authors present a rare case where radiological findings provided an important diagnostic and prognostic role in a surgical patient with abdominal sepsis. The case in interest describes an extremely rare surgical complication of intestinal Crohn’s disease (CD), namely, pylephlebitis and hepatic portal venous gas (HPVG). Key radiological findings and their clinical significance are described to further add to the limited published data available on CD with pylephlebitis and HPVG.

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Hepatic portal venous gas in Crohn's disease

BMJ Case Reports ◽

10.1136/bcr-2014-206244 ◽

2014 ◽

Vol 2014 (sep26 1) ◽

pp. bcr2014206244-bcr2014206244 ◽

Cited By ~ 3

Author(s):

G. Cunningham ◽

G. Cameron ◽

P. De Cruz

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Hepatic Portal Venous Gas ◽

Portal Venous Gas ◽

Hepatic Portal

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Hepatic portal venous gas and portal venous thrombosis following colonoscopy in a patient with terminal ileal Crohn's disease

BMJ Case Reports ◽

10.1136/bcr-2014-206854 ◽

2015 ◽

Vol 2015 (may03 1) ◽

pp. bcr2014206854-bcr2014206854 ◽

Cited By ~ 1

Author(s):

A. S. C. Ma ◽

I. Ewing ◽

C. D. Murray ◽

M. I. Hamilton

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Venous Thrombosis ◽

Hepatic Portal Venous Gas ◽

Portal Venous Gas ◽

Portal Venous Thrombosis ◽

Hepatic Portal

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Hepatic portal venous gas and intestinal pneumatosis as initial presentation of Crohn’s Disease: First case report

Journal of Crohn s and Colitis ◽

10.1016/j.crohns.2014.02.023 ◽

2014 ◽

Vol 8 (10) ◽

pp. 1329-1330 ◽

Cited By ~ 3

Author(s):

Teresa Pinto Pais ◽

Rolando Pinho ◽

João Carvalho

Keyword(s):

Crohn’S Disease ◽

Case Report ◽

Crohn's Disease ◽

Initial Presentation ◽

Hepatic Portal Venous Gas ◽

Intestinal Pneumatosis ◽

Portal Venous Gas ◽

First Case ◽

Hepatic Portal

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Management of hepatic portal venous gas and pneumatosis intestinalis in critically sick adult patients

Scandinavian Journal of Gastroenterology ◽

10.1080/00365520903030811 ◽

2009 ◽

Vol 44 (8) ◽

pp. 1019-1020 ◽

Cited By ~ 4

Author(s):

Amir Khorram-Manesh ◽

Anders Odén

Keyword(s):

Pneumatosis Intestinalis ◽

Adult Patients ◽

Hepatic Portal Venous Gas ◽

Portal Venous Gas ◽

Hepatic Portal

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A rare case of portal pneumatosis. What are the therapeutic resources?

Medical Image Database ◽

10.33695/mid.v2i1.37 ◽

2019 ◽

Vol 2 (1) ◽

pp. 15-16

Author(s):

IULIAN SLAVU ◽

Daniela Mihaila ◽

Lucian Alecu

Keyword(s):

Decompression Sickness ◽

Stable Condition ◽

Pneumatosis Intestinalis ◽

Clinical State ◽

Hepatic Portal Venous Gas ◽

Severe Condition ◽

Gastric Distention ◽

Ischemic Bowel ◽

Portal Venous Gas ◽

Hepatic Portal

Hepatic portal vein gas was first describes in 1955 by Wolf and Evans. It is a rare and severe condition that in 80% of cases leads to patient’s death. Most common causes are :necrotizing enterocolitis, mesenteric ischemia, sepsis , intestinal perforation. A 73-year old male patient underwent an elective rectal amputation for anal adenocarcinoma, after radiotherapy.In the 12th postoperative day the clinical state of the patient degraded, with onset of acute abdominal pain and fever.A CT scan and ultrasound examination showed the presence of hepatic portal venous gas with of pneumatosis intestinalis and an abcess in the pelvic region.Intraoperatively, two small perforations were found at the distal jejunun with no ischemia or necrosis. An ileostomy was performed, with drainage of the peritoneal cavity.Post-operatively the patient was stabilized and was eventually discharged in stable condition .The presence of hepatic portal venous gas with the of pneumatosis intestinalis is most frequently associated with ischemic bowel, ileus, diverticulitis, gastric distention, inflammatory bowel disease (IBD), hypotension post dialysis treatment, decompression sickness, trauma and iatrogenic causes from instrumentation and recent surgery.

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