scholarly journals Portomesenteric Venous System Gas after CT Colonography: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Ilaria Sansoni ◽  
Claudia Lucia Piccolo ◽  
Ilenia Di Giampietro ◽  
Matteo Polacco ◽  
Bruno Beomonte Zobel
Keyword(s):  
Ct Scan ◽  
Ct Colonography ◽  
Pneumatosis Intestinalis ◽  
Clinical Findings ◽  
Bowel Ischemia ◽  
Colonic Perforation ◽  
Venous System ◽  
Portal Venous System ◽  
Portal Venous Gas ◽  
Mucosal Integrity

Portomesenteric vein gas can occur owing to a variety of interraleted factors such as loss of mucosal integrity and intraluminal overpressure, and the most common and serious cause is bowel ischemia, which requires urgent laparotomy. Nevertheless, when portal venous gas is caused by nonischemic causes, surgery is not required and it can be treated conservatively. So, its features should be carefully evaluated at CT scan, together with clinical findings. The authors report a case of an old male with portomesenteric venous system gas after CT colonography, without evidence of pneumatosis intestinalis or colonic perforation. A CT scan without enema was required after 24 hours in absence of worsened patient conditions, revealing the disappearance of gas in mesenteric vein and in the portal venous system.

Gas Embolism After Ingestion of Hydrogen Peroxide

PEDIATRICS ◽  
1990 ◽  
Vol 85 (4) ◽  
pp. 593-594
Author(s):  
WAYNE R. RACKOFF ◽  
DAVID F. MERTON
Keyword(s):  
Hydrogen Peroxide ◽  
Case Report ◽  
Venous System ◽  
Hydrogen Peroxide Solution ◽  
Portal Venous System ◽  
Gas Embolism ◽  
Colonic Irrigation ◽  
Radiographic Evidence ◽  
Portal Venous Gas ◽  
Venous Gas Embolism

Gas embolism to the portal venous system is a well-recognized radiographic sign in infants with necrotizing enterocolitis. It also has been seen after colonic irrigation with hydrogen peroxide solution.1,2 We present what we believe is the first reported patient with radiographic evidence of portal venous gas embolism after ingestion of hydrogen peroxide solution. This finding is important because gas embolism to the portal venous system after colonic irrigation with hydrogen peroxide has been associated with gangrenous and perforated bowel.1,2 CASE REPORT A 2-year-old boy ingested an unknown amount of 3% hydrogen peroxide solution. The child was found with foam around his mouth.

PS02.152: DEVELOPMENT OF INTESTINAL PNEUMATOSIS AND PORTAL VENOUS GAS AFTER ESOPHAGECTOMY IS NOT INDICATIVE OF ISCHEMIC BOWEL AND CAN BE SUCCESSFULLY MANAGED NON-OPERATIVELY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 164-164
Author(s):  
Erin Gillaspie ◽  
Micheal Moynagh ◽  
Sameh Said ◽  
Mark Allen ◽  
Shanda Blackmon ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Case Series ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Tube Placement ◽  
Jejunostomy Tube ◽  
Radiographic Findings ◽  
Intestinal Pneumatosis ◽  
Ischemic Bowel ◽  
Portal Venous Gas

Abstract Background Pneumatosis intestinalis has long been a marker of advanced bowel ischemia and prompts urgent laparotomy. In post-operative settings, the presence of pneumatosis represents a significant management dilemma. We share a case-series of post-esophagectomy patients with pneumatosis intestinalis and no corollary intra-abdominal pathologic findings on re-exploration. Methods January 2000 to December 2017, 1760 patients underwent Ivor-Lewis esophagectomy or gastrectomy with jejunostomy-tube placement. Charts were reviewed retrospectively to identify patients with pneumatosis intestinalis discovered in the post-operative period. Demographic data, operative details and postoperative course were reviewed including incidence and details of re-exploration. Results Eleven patients met inclusion criteria. Nine were male (81.8%) and mean age was 69 years. All patients had radiographic confirmation of pneumatosis intestinalis and in many cases portal venous gas (Figure 1). Clinical course was variable without discernable trends in vitals or laboratory values. Development of significant postoperative ileus along with delivery of enteral tube feeds through a jejunostomy tube preceded development of the pneumatosis in all patients. Nine patients were re-explored and none had evidence of bowel ischemia. Conclusion The finding of pneumatosis intestinalis in the post-operative setting can be alarming and pose a management dilemma. With the advent of improved and readily available imaging, there has been an increase in findings that have no corollary physical symptomatology. In this series of patients, despite dramatic radiographic findings, none had ischemic bowel. Pneumatosis intestinalis alone in patients who have undergone esophagectomy should not be considered an indication for emergency re-exploration. Disclosure All authors have declared no conflicts of interest.

Extensive Portal Venous Gas and Pneumatosis Intestinalis in the Absence of Small Bowel Ischemia or Infarction

2007 ◽  
Vol 102 ◽  
pp. S373-S374
Author(s):  
Pavan K. Pinnamaneni ◽  
Parupudi V.J. Sriram ◽  
David Hodges ◽  
Ari Halldorsson
Keyword(s):  
Small Bowel ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Portal Venous Gas

Pneumatosis Intestinalis and Gas in the Portal Venous System

2006 ◽  
Vol 10 (5) ◽  
pp. 781-782 ◽  
Author(s):  
J GRIFFITH ◽  
M APOSTOLAKOS ◽  
R SALLOUM
Keyword(s):  
Pneumatosis Intestinalis ◽  
Venous System ◽  
Portal Venous System

Pneumatosis Intestinalis and Portal Venous Gas Without Bowel Ischemia in a Patient Treated with Irinotecan and Cisplatin

2007 ◽  
Vol 53 (1) ◽  
pp. 217-219 ◽  
Author(s):  
David Kung ◽  
Daniel T Ruan ◽  
Rodney K. Chan ◽  
Melissa L. Ericsson ◽  
Mandeep S. Saund
Keyword(s):  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Portal Venous Gas

scholarly journals Association of Contrast-Enhanced CT Findings with Etiology and Outcome in Patients with Portal Venous Gas and Pneumatosis Intestinalis: A Single Center Case Series Study

2021 ◽  
Author(s):  
Naohiro Yoshida ◽  
Yoshihiko Sadakari ◽  
Kazuhito Tamehiro ◽  
Kazuma Ohkawara ◽  
Hiroyuki Nakane ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Portal Venous Gas ◽  
Ct Findings ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
The Relationship ◽  
Group 1

Abstract Background: Contrast-enhanced computed tomography (CT) is a reliable diagnostic tool often used to investigate the etiology of portal venous gas (PVG) and pneumatosis intestinalis (PI). However, there are few reports that offer an analysis of the relationship between particular CT findings and clinical outcomes. In this paper, we sought to close that gap and present the results of our analyses that reveal which CT findings are correlated with life-threatening cases.Methods: 39 patients were diagnosed with PVG or PI from contrast-enhanced CT scans and underwent treatment at St. Mary’s Hospital from January 2009 to December 2018. We reviewed patients’ medical charts, laboratory data, and CT scan images retrospectively. We defined cases resulting in operation or death as group 1, and patients with conservative treatment who survived as group 2. We then analyzed the relationship between each CT finding and clinical feature.Results: The primary underlying diseases identified for PVG and PI were bowel ischemia (13/39), enteritis (9/39), constipation (5/39), iatrogenic disease (4/39), and hemodialysis (3/39). Poor enhancement of the intestinal wall and extrahepatic venous gas were correlated with bowel ischemia (p=0.0002 and p=0.0003, respectively). Free air was less correlated with bowel ischemia (p=0.02). Wall thickness was correlated with enteritis (p=0.02). Mortality in cases with bowel ischemia and perforation was quite high (60%) even if patients underwent surgery (33.3%). Conversely, patients with enteritis, constipation, hemodialysis and gastric dilatation who did not require surgery resulted in more favorable outcomes with conservative treatment. In the multivariate analysis, extra hepatic venous gas was the only solitary factor correlated with group 1 (p=0.0008).Conclusions: Extra hepatic venous gas was the strongest predictive factor of clinical outcome in contrast-enhanced CT findings correlated with bowel ischemia and required surgical treatment. The other CT findings were useful in diagnosing the underlying disease, but were not correlated with clinical outcomes. The necessity for surgical treatment remains dependent on the root cause.

scholarly journals Gastric Pneumatosis With Portal Venous Gas Can Be Treated Non-operatively: a Retrospective Multi-institutional Study

2021 ◽  
Author(s):  
Antoine Epin ◽  
Guillaume Passot ◽  
Niki Christou ◽  
Olivier Monneuse ◽  
Jean-Yves Mabrut ◽  
...  
Keyword(s):  
Ct Scan ◽  
Lactate Level ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Laboratory Data ◽  
Bowel Ischemia ◽  
Gastric Dilatation ◽  
Arterial Lactate ◽  
Portal Venous Gas ◽  
Arterial Lactate Level

Abstract Background: Gastric pneumatosis (GP) is a rare radiologic finding with an unpredictable prognosis. The aim of this study was to identify mortality risk factors from patients presenting with GP on computed tomography (CT), and to develop a model which would allow us to predict which patients would benefit most from operative management.Methods: Between 2010 and 2020, all CT-scan reports in 4 tertiary centers were searched for the following terms: “gastric pneumatosis”, “intramural gastric air” or “emphysematous gastritis”. The retrieved CT scans were reviewed by a senior surgeon and a senior radiologist. Relevant clinical and laboratory data for these patients were extracted from the institutions’ medical records. Results: Among 58 patients with GP portal venous gas and bowel ischemia were present on CT scan in 52 (90%) and 17 patients (29%), respectively. The 30-day mortality rate was 31%. Univariate analysis identified the following variables as predictive of mortality at the time of the diagnosis of GP: abdominal guarding, hemodynamic instability, arterial lactate level >2mmol/l, and absence of gastric dilatation. Multivariable analysis identified the following variables as independent predictors of mortality: arterial lactate level (OR: 1.39, 95% CI: 1.07 - 1.79) and absence of gastric dilatation (OR: 0.07, 95% CI: 0.01 - 0.79). None of the patients presenting with a baseline lactate rate <2 mmol/l died within 30 days following diagnosis, and no more than 17 patients out of 58 had bowel ischemia (29%).Conclusions: GP could be managed non-operatively, even in the presence of portal venous gas. However patients with arterial lactate level>2mmol/l, or absence of gastric dilation should be surgically explored due to a non-negligible risk of mortality.

scholarly journals Portal pyaemia secondary to colonic perforation

2019 ◽  
Vol 12 (4) ◽  
pp. e228400
Author(s):  
Chee Siong Wong ◽  
Gyuseong Cho ◽  
Edmund M Godfrey ◽  
Simon Harper
Keyword(s):  
Surgical Management ◽  
Abdominal Sepsis ◽  
Colonic Perforation ◽  
Venous System ◽  
High Fever ◽  
Portal Venous System ◽  
Liver Abscesses

Portal pyaemia or pylephlebitis is a form of septic (often suppurative) thrombophlebitis of the portal venous system. It may develop as a complication of intra-abdominal sepsis, such as diverticulitis or appendicitis. Patients typically present with a high fever that is sometimes accompanied by jaundice. We report a case of portal pyaemia associated with multiple liver abscesses and discuss the medical and surgical management of this condition.

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