Pneumatosis intestinalis and hepatic portal venous gas

  • Masahiro Ito
  • Akihiko Horiguchi
  • Shuichi Miyakawa
Case Reports of Interest


We report two cases of pneumatosis intestinalis and hepatic portal venous gas. The first case was in a 67-year-old woman who complained of strong right lower abdominal pain and high fever on the twelfth day after pancreatoduodenectomy (PD) with portal vein (PV) resection. Abdominal X-ray and computed tomography showed hepatic portal venous gas and pneumatosis intestinalis. The emergency laparotomy performed disclosed extensive necrosis of the bowel from the jejunum to the ascending colon. All necrotic parts of the bowel were resected and a jejunostomy was performed. The residual intact small intestine was 30 cm in length. Her postoperative course was stable. This is a rare complication after PD and cannot be cured by any other treatment but surgery. The second case was in a 45-year-old woman with the chief complaint of abdominal pain and constipation. She had a past history of chronic toluene inhalation. Abdominal X-ray and computed tomography also showed hepatic portal venous gas and pneumatosis intestinalis, as well as free air, but no physical examination or laboratory test results supported a diagnosis of bowel necrosis. Hyperbaric oxygen (HBO) therapy effectively controlled the symptoms and signs.

Key words

Pneumatosis intestinalis Hepatic portal venous gas PD operation Hyperbaric oxygen therapy 


  1. 1.
    Boerner RM, Fried DB, Warshauer DM, Isaacs K. Pneumatosis intestinalis: two case reports and retrospective review of the literature from 1985 to 1995. Dig Dis Sci 1996;41:2272–2285.PubMedCrossRefGoogle Scholar
  2. 2.
    Heng Y, Schuffer MD, Haggitt RC, Rohrmann CA. Pneumatosis intestinalis: a review. Am J Gastroenterol 1995;90:1747–1758.PubMedGoogle Scholar
  3. 3.
    Meyers MA, Ghahremani GG, Clements JL Jr, Goodman K. Pneumatosis intestinalis. Gastrointest Radiol 1977;2:91–105.PubMedCrossRefGoogle Scholar
  4. 4.
    Liebman PR, Patten MT, Manny J, Benfield JR, Hechtman HB. Hepatic-portal venous gas in adult: etiology, pathophysiology and clinical significance. Am Surg 1978;187:281–287.Google Scholar
  5. 5.
    Bloom RA, Lebensart PD, Levy P, Craciun E, Anner H, Manny J. Survival after ultrasonographic demonstration of portal venous gas due to mesenteric artery occlusion. Postgrad Med J 1990;66:137–139.PubMedGoogle Scholar
  6. 6.
    Friedman D, Flancbaum L, Ritter E, Trooskin SZ. Hepatic portal venous gas identified by computed tomography in a patient with blunt abdominal trauma: a case report. J Trauma 1991;31:290–292.PubMedCrossRefGoogle Scholar
  7. 7.
    Ohkubo M, Nagino M, Kamiya J, Arai J, Nishio H, Nimura Y. Portal and mesenteric vein thrombosis after portal vein embolization in a patient with protein S deficiency. J Hepatobiliary Pancreat Surg 2004;11:338–341.PubMedCrossRefGoogle Scholar
  8. 8.
    Morimoto Y, Yamamoto T, Tanaka Y, Hiranaka T, Kim M. Recurrent hepatic portal venous gas in a patient with hemodialysis-dependent chronic renal failure. J Hepatobiliary Pancreat Surg 2001;8:274–278.PubMedCrossRefGoogle Scholar
  9. 9.
    Yamaguchi K, Tanaka M, Chijiiwa K, Nagakawa T, Imamura M, Takada T. Early and late complications of pylorus-preserving pancreatoduodectomy in Japan 1998. J Hepatobiliary Pancreat Surg 1999;6:303–311.PubMedCrossRefGoogle Scholar
  10. 10.
    Wolfe JN, Evans WA. Gas in the portal vein of the liver in infant. AJR Am J Roentgenol Radium Ther Nucl Med 1955;74:486–489.Google Scholar
  11. 11.
    Bell RS, Graham CB, Stenenson JK. Roentgenologic and Clnical manifestations of neonatal necrotizing enterocolitic Experience with 43 cases. Ann J Roentgenol Radiun Ther Nud Med 1971;112:123–134.Google Scholar

Copyright information

© Springer Japan 2008

Authors and Affiliations

  • Masahiro Ito
    • 1
  • Akihiko Horiguchi
    • 1
  • Shuichi Miyakawa
    • 1
  1. 1.Second Department of Gastroenterological SurgeryFujita-Health University, School of MedicineAichiJapan

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