Hepatic portal venous gas caused by blunt abdominal trauma: is it a true ominous sign of bowel necrosis? Report of a case

Surg Today. 2002;32(7):655-8. doi: 10.1007/s005950200120.

Abstract

A case of transient portal venous gas in the liver following blunt abdominal trauma is described. Computed tomography (CT) demonstrated hepatic portal venous gas 4 h after the injury. An exploratory laparotomy revealed segmental necrosis of the small intestine with a rupture of the bladder. Pneumatosis intestinalis was evident on the resected bowel. A histopathologic study revealed congestion and bleeding in the bowel wall and a great deal of the mucosa had been lost because of necrosis. However, neither thrombus nor atherosclerotic changes were observed in the vessels. A bacteriological examination demonstrated anaerobic bacteria from the bowel mucosa, which was most likely to produce portal venous gas. Although the present case was associated with bowel necrosis, a review of literature demonstrated that portal venous gas does not necessarily indicate bowel necrosis in trauma patients. There is another possibility that the portal venous gas was caused by a sudden increase in the intra-abdominal pressure with concomitant mucosal disruption, which thus forced intraluminal gas into the portal circulation in the blunt trauma patients.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Injuries / complications*
  • Gases
  • Humans
  • Intestinal Diseases / etiology*
  • Intestinal Diseases / pathology*
  • Intestine, Small / pathology*
  • Male
  • Middle Aged
  • Necrosis
  • Pneumoperitoneum / complications
  • Pneumoperitoneum / etiology*
  • Portal Vein
  • Prognosis
  • Wounds, Nonpenetrating / complications*

Substances

  • Gases