Portal venous gas in intestinal malrotation with mild midgut volvulus

Springer Science and Business Media LLC - 2019
Ryoji Hirose1, H. Kai1, Kaori Inatomi1, Tsuyoshi Iwanaka1, Naomi Morishima2, Momotoshi Ikeda3, Reiko Masaki3, Atsushi Iwasaki1
1Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
2Division of Pediatrics, Fukuoka Central Hospital, 2-6-11, Yakuin Chuo-ku, Fukuoka, 810-0022, Japan
3Division of Radiological Technologist, Fukuoka Central Hospital, 2-6-11, Yakuin Chuo-ku, Fukuoka, 810-0022, Japan

Tóm tắt

Abstract Background Portal venous gas has been considered as a radiological sign requiring urgent operative intervention; however, the reports concerning portal venous gas associated with favorable outcome are recently increasing. Case presentation We describe a 9-month-old boy with acute onset high fever and vomiting. The ultrasonography demonstrated micro-gas bubbles continuously floating in the intrahepatic portal vein. Contrast-enhanced CT, performed 1 h later from echography, revealed a whirlpool sign suggesting an intestinal malrotation with midgut volvulus, but with no signs of residual intrahepatic gas. Operative findings showed a mild volvulus with neither congestion nor ischemic change of the twisted bowel. Detorsion and Ladd’s procedure were completed laparoscopically. Conclusions Transient portal venous gas bubbles may be generated even in the mild intestinal volvulus with no bowel ischemia. Ultrasonography can be a sensitive detector to visualize such small amounts of gas.

Từ khóa


Tài liệu tham khảo

Arnon RG, Fishbein JF. Portal venous gas in the pediatric age group. Review of the literature and report of twelve new cases. J Pediatr. 1971;79:255–9.

Abboud B, El Hachem J, Yazbeck T, Doumit C. Hepatic portal venous gas: physiopathology, etiology, prognosis and treatment. World J Gastroenterol. 2009;15:3585–90.

Merritt CRB, Goldsmith JP, Sharp MJ. Sonographic detection of portal venous gas in infants with necrotizing enterocolitis. AJR Am J Roentgenol. 1984;143:1059–62.

Miskin M, Reilly BJ. Gas in the intestinal wall and portal venous system in infants. Can Med Assoc J. 1969;101:129–34.

Eggli KE, Loyer E, Anderson K. Neonatal pneumatosis cystoides intestinalis caused by volvulus of the mid intestine. Arch Dis Child. 1989;64:1189–90.

Yip CK, et al. Sonographic recognition of pneumatosis intestinalis and portal gas in an 11-months-old infant. Australas Radiol. 1990;34:169–71.

Bohnhorst B, et al. Portal venous gas detected by ultrasound differentiates surgical NEC from other acquired neonatal intestinal diseases. Eur J Pediatr Surg. 2011;21:12–7.

Sharma R, Tepas JJ 3rd, Hudak ML, Wludyka PS, Mollitt DL, Garrison RD, Bradshaw JA, Sharma M. Portal venous gas and surgical outcome of neonatal necrotizing enterocolitis. J Pediatr Surg. 2005;40:371–6.

Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Thông tin tác giả