Emergency Radiology

, Volume 12, Issue 4, pp 164–170 | Cite as

Detection of hepatic portal venous gas: its clinical impact and outcome

  • Sebastian T. Schindera
  • Juergen Triller
  • Peter Vock
  • Hanno HoppeEmail author
Original Article


The clinical impact and outcome of a rare radiographic finding of hepatic portal venous gas (HPVG) as well as the effectiveness of computed tomography (CT), CT scanogram, and conventional radiography in the detection of HPVG were retrospectively analyzed. CT scans, CT scanogram, and plain film radiographs of 11 patients with HPVG were reviewed and compared with their medical records and surgical and pathology reports. Eight of the 11 patients underwent plain film radiographs 1 day before or after the CT scan. HPVG was detected at CT in all 11 patients, on CT scanogram in three (3 of 11, 27.3%), and on plain films in one (one of eight, 12.5%). In nine of 11 patients (81.8%), CT revealed an associated pneumatosis intestinalis. In six of the 11 patients (54.6%), acute mesenteric ischemia was the underlying disease for HPVG. Seven patients (63.6%) underwent emergency exploratory laparotomy. The mortality rate for HPVG alone was 27.3% (3 of 11) and for HPVG related to mesenteric bowel disease 50% (three of six). Acute mesenteric ischemia is the most common cause of HPVG, which continues to have a predictably higher mortality. CT is superior to CT scanograms and radiographs in the detection of HPVG and its underlying diseases and, therefore, should be used as the primary diagnostic tool.


Computed tomography Portal venous gas Mesenteric infarction 


  1. 1.
    Sebastia C, Quiroga S, Espin E, Boye R, Alvarez-Castells A, Armengol M (2000) Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis. Radiographics 20:1213–1224PubMedGoogle Scholar
  2. 2.
    Hong JJ, 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 132:1071–1075PubMedGoogle Scholar
  3. 3.
    Wiesner W, Mortele KJ, Glickman JN, Ji H, Ros PR (2002) Portal-venous gas unrelated to mesenteric ischemia. Eur Radiol 12:1432–1437PubMedCrossRefGoogle Scholar
  4. 4.
    Wolfe JN, Evans WA (1955) Gas in the portal veins of the liver in infants: a roentgenographic demonstration with postmortem anatomical correlation. Am J Roentgenol 74:486–488Google Scholar
  5. 5.
    Susman N, Senturia HR (1960) Gas embolization of the portal venous system. Am J Roentgenol 83:847–850Google Scholar
  6. 6.
    Liebman PR, Patten MT, Manny J, Benfield JR, Hechtman HB (1978) Hepatic-portal venous gas in adults: etiology, pathophysiology and clinical significance. Ann Surg 187:281–287PubMedCrossRefGoogle Scholar
  7. 7.
    Faberman RS, Mayo-Smith WW (1997) Outcome of 17 patients with portal venous gas detected by CT. Am J Roentgenol 169:1535–1538Google Scholar
  8. 8.
    Zhang D, Weltman D, Baykal A (1999) Portal vein gas and colonic pneumatosis after enema, with spontaneous resolution. Am J Roentgenol 173:1140–1141Google Scholar
  9. 9.
    Draghetti MJ, Salvo AF (1999) Gas in the mesenteric veins as a nonfatal complication of diverticulitis: report of a case. Dis Colon Rectum 42:1497–1498PubMedCrossRefGoogle Scholar
  10. 10.
    Gurland B, Dolgin SE, Shlasko E, Kim U (1998) Pneumatosis intestinalis and portal vein gas after blunt abdominal trauma. J Pediatr Surg 33:1309–1311PubMedCrossRefGoogle Scholar
  11. 11.
    Kirsch M, Bozdech J, Gardner DA (1990) Hepatic portal venous gas: an unusual presentation of Crohn’s disease. Am J Gastroenterol 85:1521–1523PubMedGoogle Scholar
  12. 12.
    Wu JW, Chen MY, Auringer ST (2000) Portal venous gas: an unusual finding in child abuse. J Emerg Med 18:105–107PubMedCrossRefGoogle Scholar
  13. 13.
    Schulze CG, Blum U, Haag K (1995) Hepatic portal venous gas. Imaging modalities and clinical significance. Acta Radiol 36:377–380PubMedCrossRefGoogle Scholar
  14. 14.
    Peloponissios N, Halkic N, Pugnale M et al (2003) Hepatic portal gas in adults: review of the literature and presentation of a consecutive series of 11 cases. Arch Surg 138:1367–1370PubMedCrossRefGoogle Scholar
  15. 15.
    Peter SD, Abbas MA, Kelly KA (2003) The spectrum of pneumatosis intestinalis. Arch Surg 138:68–75CrossRefGoogle Scholar
  16. 16.
    Yoshida M, Mitsuo M, Kutsumi H et al (1996) A successfully treated case of multiple liver abscesses accompanied by portal venous gas. Am J Gastroenterol 91:2423–2425PubMedGoogle Scholar
  17. 17.
    Scheidler J, Stabler A, Kleber G, Neidhardt D (1995) Computed tomography in pneumatosis intestinalis: differential diagnosis and therapeutic consequences. Abdom Imaging 20:523–528PubMedCrossRefGoogle Scholar
  18. 18.
    Wiesner W, Mortele KJ, Glickman JN, Ji H, Ros PR (2001) Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. Am J Roentgenol 177:1319–1323Google Scholar
  19. 19.
    Smerud MJ, Johnson CD, Stephens DH (1990) Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases. Am J Roentgenol 154:99–103Google Scholar
  20. 20.
    Wiesner W, Hauser A, Steinbrich W (2004) Accuracy of multidetector row computed tomography for the diagnosis of acute bowel ischemia in a non-selected study population. Eur Radiol 14:2347–2356PubMedCrossRefGoogle Scholar
  21. 21.
    Wiesner W, Khurana B, Ji H, Ros PR (2003) CT of acute bowel ischemia. Radiology 226:635–650PubMedCrossRefGoogle Scholar
  22. 22.
    Monneuse O, Gruner L, Henry L et al (2000) Hepatic portal venous gas. Ann Chir 125:435–438PubMedCrossRefGoogle Scholar
  23. 23.
    Kinoshita H, Shinozaki M, Tanimura H et al (2001) Clinical features and management of hepatic portal venous gas: four case reports and cumulative review of the literature. Arch Surg 136:1410–1414PubMedCrossRefGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2006

Authors and Affiliations

  • Sebastian T. Schindera
    • 1
  • Juergen Triller
    • 1
  • Peter Vock
    • 1
  • Hanno Hoppe
    • 1
    Email author
  1. 1.Department of Diagnostic RadiologyUniversity Hospital of Bern, InselspitalBernSwitzerland

Personalised recommendations