Intermittent hepatic portal vein gas complicating diverticulitis—a case report and literature review

International Journal of Colorectal Disease - Tập 22 - Trang 1395-1399 - 2007
Franz Sellner1, Babak Sobhian1, Martina Baur2, Stephanie Sellner1, Barbara Horvath3, Margit Mostegel4, Josef Karner1, Stefan Staettner1
1Department of Surgery, Kaiser Franz Josef Hospital, Vienna, Austria
2Medical Department III, Kaiser Franz Josef Hospital, Vienna, Austria
3Department of Radiology, Kaiser Franz Josef Hospital, Vienna, Austria
4Department of Pathology and Bacteriology, Kaiser Franz Josef Hospital, Vienna, Austria

Tóm tắt

This report describes a case of intermittent hepatic portal venous gas (HPVG) because of colonic diverticulitis in a 48-year-old man, who was successfully treated by surgery. Based on an extensive literature search, which produced 21 observations, the etiology, symptoms, imaging features, clinical significance, treatment strategy, and outcome of HPVG because of colonic diverticulitis are evaluated: While observations with an underlying intramesocolic abscess carry a favorable prognosis, the prognosis of observations because of septic thrombophlebitis with gas forming germs is poor.

Tài liệu tham khảo

Sonnenshein M, Cone L, Alexander R (1986) Diverticulitis with colovenous fistula and portal venous gas. Report of two cases. J Clin Gastroenterol 8:195–198 Graham G, Bernstein R, Gronner A (1975) Gas in the portal and inferior mesenteric veins caused by diverticulitis of the sigmoid colon. Report of a case with survival. Radiology 114:601–602 Fataar S, Cadogan E, Spruyt O (1986) Ultrasonography of hepatic portal vein gas due to diverticulitis. Br J Radiol 59:183–185 Jensen JA, Tsang D, Minnis JF, Ponn Th, Merell RC (1985) Pyelophlebitis and intramesocolic perforation. Am J Surg 150:284–287 Haak H, Kooymans-Coutinho M, von Teeffelen M, Adhin N, Falke T (1990) Portal venous gas in a patient with diverticulitis. Hepatogastroenterology 37:528–529 Zielke A, Hasse C, Rothmund M (1998) Hepatic-portal venous gas in acute colonic diverticulitis. Surg Endosc 12:278–280 Maher M, Tonra M, Malone D, Gibney RG (2001) Portal. venous gas: detection by gray-scale and Doppler sonography in the absence of correlative findings on computed tomography. Abdom Imaging 26:390–394 Wiesner W, Mortele K, Glickman J, Ji H, Ros P (2001) Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. Am J Roentgenol 177:1319–1323 Dyer E, Faragher I (2005) Computer tomography finding of portal venous gas in a patient who survived mesenteric infarction. ANZ J Surg 75:363–364 Fukumori D, Sasaki T, Matsumoto H, Ohmori H, Kakazu T, Yamamoto F (2003) Necrotizing enteritis with hepatic portal vein gas and pneumatosis intestini: report of a case. Eur J Gastroenterol Hepatol 15:201–203 Chiu H, Chen C, Lu Y, Lin J, Mo L (2005) Hepatic portal vein gas. Am J Surg 189:501–503 Faberman R, Mayo-Smith W (1997) Outcome of 17 patients with portal venous gas detected by CT. Am J Roentgenol 169:1535–1538 Brown M, Hauschildt J, Casola G, Gosink B, Hoyt D (1999) Intravascular gas as an incidental finding at US after blunt abdominal trauma. Radiology 210:2423–2425 Sebastia C, Quiroga S, Espin E, Boye R, Alvarez-Castells A, Armengol M (2000) Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis. Radiographics 20:1213–1224 Furuya Y, Yasuhara H, Ariki K, Yanagie H, Naka S, Nojiri T, Nagao T (2002) Hepatic portal vein gas caused by blunt abdominal trauma. Is it true an ominous sign of bowel necrosis? Report of a case. Surg Today 32:655–658 Hong J, Gadaleta D, Rossi P, Esquivel J, Davis JM (1997) Portal vein gas, a changing clinical entity. Report of 7 patients and review of the literature. Arch Surg 132:1071–1075 Little A, Ellis S (2003) “Benign” hepatic portal venous gas. Australas Radiol 47:309–312 Quirke TE (1995) Hepatic-portal venous gas associated with ileus. Am Surg 61:1084–1086 Venogopal C, Colley DP (1990) Portal venous gas in a patient with Crohn’s disease. J Clin Gastroenterol 12:595–597 Birnberg F, Gore R, Shragg B, Margulis A (1983) Hepatic portal venous gas: a benign finding in a patient with ulcerative colitis. J Clin Gastroenterol 5:89–91 Wiesner W, Mortele K, Glickman J, Ji H, Ros P (2002) Portal-venous gas unrelated to mesenteric ischemia. Eur Radiol 12:1432–1437 Schilling E, Stückle C, Kirchner J, Donnerstag F, Liermann D (2000) Computerized tomography detection of portal vein air accumulation in severe gastroenteritis during chemotherapy. Wien Klin Wochenschr 112:80–83 Levin M, Pocard M, Caplin S, Blain A, Tubiana JM, Parc R (2002) Benign hepatic portal venous gas following caustic ingestion. Eur Radiol 12:59–61 North JH, Nava HR (1995) Pneumatosis intestinalis and portal venous air associated with needle catheter jejunostomy. Am Surg 61:1045104–1045108 Kees CJ, Hester CL (1972) Portal vein gas following barium enema examination. Radiology 102:525–526 Herron D, Vernon J, Gryska P, Reines H (1999) Venous gas embolism during endoscopy. Surg Endosc 13:276–279 Blind PJ, Oberg L, Hedberg B (1991) Hepatic portal vein gas following endoscopic retrograde cholangiography with sphincterotomy. Eur J Surg 157:299–300 Chezmar J, Nelson R, Bernardino M (1989) Portal venous gas after hepatic transplantation; sonographic detection and clinical significance. Am J Roentgenol 153:1203–1205 Najafian H, Habibi M, Reilly T (2003) Hepatic portal vein gas: clinical features and outcomes. Am Surg 69:526–529 Hou S, Chern C, How C, Chen J, Wang L, Lee C (2004) Hepatic portal vein gas: clinical significance of computed tomography findings. Am J Emerg Med 22:214–218 Brandon T, Bogart B, ReMine S, Urban L (2000) Early recognition of hepatic portal vein gas on CT with appropriate surgical intervention improves patient survival. Curr Surg 57:452–455 Cambria R, Margolies M (1982) Hepatic portal vein gas in diverticulitis: survival in a steroid treated case. Arch Surg 117:834–835 Burgard G, Cuilleron M, Cuilleret J (1993) An unusual complication of perforated sigmoid diverticulitis: gas in the portal vein with miliary liver abscesses. J Chir (Paris) 130:237–239 Rossmann M, Burr L, Thorpe P (1997) Colovenous fistula complicating diverticulitis: CT and radiographic findings. Abdom Imaging 22:513–515 Häner C, Inderbitzi R, Badulescu M, Teucher J (1998) Septic pylephlebitis with detection of gas in the portal vein: a rare complication of sigmoid diverticulitis. Schweiz Med Wochenschr 128:1339–1344 Heye S, Ghijselinos L, van Campenhoudt M (2002) Hepatic portal main gas as a complication of diverticulitis with a colovenous fistula: a case report. Emerg Radiol 9:234–236 D’Angelo M (2003) Case of the month. Diverticulitis with portomesenteric vein gas. Crit Rev Comput Tomogr 44:315–320 White T, Allen H, Ives C (1998) Portal and mesenteric vein gas in diverticulitis: CT findings. Am J Roentegenol 71:525–526 Ai-Toma A, Nix M, Brink M (2004) Image of the month: diverticulitis of the sigmoid colon. Gastroenterology 126:393, 634 Yochida M, Mitsuo M, Kutsumi H, Fujita T, Soga T, Nishimura K, Kawabata K, Kadotani Y, Kinoshita Y, Chiba T, Kuroiwa N, Fujimoto S (1995) A successfully treated case of multiple liver abscesses accompanied by portal vein gas. Am J Gastroenterol 91:2423–2425