Abstract
Portal pneumatosis is a rare diagnostic factor, which is often associated with ischemic intestinal accidents. It has been associated with a negative prognosis for a very long time, and the presence of portal pneumatosis is usually an indication for the need to perform a laparotomy. A 68-year-old male patient with diabetes, obstructive lung disease, and a previous cerebral stroke associated with left hemiplegia presented with abdominal pain, fever and neutrophil leukocytosis. Computed tomography (CT) scan showed the presence of portal pneumatosis with signs of acute cholecystitis and remarkable gastrectasia. In consideration of the serious clinical picture, the patient first underwent esophagogastroduodenal endoscopy (EGDS), which showed ulcerative hemorrhagic gastritis. He then underwent a laparoscopic cholecystectomy. The histology results confirmed the intraoperative diagnosis of gangrenous cholecystitis. The patient was discharged on the 7th postoperative day. With the use of new diagnostic techniques, especially CT, the incidence of portal pneumatosis has increased and consequently the clinical approach of surgeons to this pathology is also changing. Indeed, when portal pneumatosis is not associated with intestinal ischemia, the therapeutic approach must be guided by the clinical condition of the patient and by the investigation of the causes of this pathology. The laparoscopic approach can be extremely useful either in the diagnosis (if this has not been achieved by noninvasive means) or in treatment, if possible, of the causes implicated by the portal pneumatosis.
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References
Wolfe JN, Evans WA. Gas in the portal veins of the liver in infants; a roentgenographic demonstration with postmortem anatomical correlation. Am J Roentgenol Radium Ther Nucl Med 1955;74(3):486–488.
Dennis MA, Pretorius D, Manco-Johnson ML, Bangert-Burroughs K. CT detection of portal venous gas associated with suppurative cholangitis and cholecystitis. Am J Roentgenol 1985;145(5):1017–1018.
Monneuse O, Pilleul F, Barth X, Gruner L, Allaouchiche B, Valette PJ, et al. Portal venous gas detected on computed tomography in emergency situations: surgery is still necessary. World J Surg 2007;31(5):1065–1071.
Sebastià C, Quiroga S, Espin E, Boyé R, Alvarez-Castells A, Armengol M. Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis. Radiographics 2000;20(5):1213–1224; discussion 1224–6
Akatsu T, Tanabe M, Shimizu T, Handa K, Kawachi S, Aiura K, et al. Pseudoaneurysm of the cystic artery secondary to cholecystitis as a cause of hemobilia: report of a case. Surg Today 2007;37(5):412–417.
Kinoshita H, Shinozaki M, Tanimura H, Umemoto Y, Sakaguchi S, Takifuji K, et al. Clinical features and management of hepatic portal venous gas: four case reports and cumulative review of the literature. Arch Surg 2001;136(12):1410–1414.
Chiu HH, Chen CM, Lu YY, Lin JC, Mo LR. Hepatic portal venous gas. Am J Surg 2005;189(4):501–503.
Muscari F, Suc B, Lagarrigue J. Hepatic portal venous gas: is it always a sign of severity and surgical emergency? Chirurgie 1999;124(1):69–72.
Faberman RS, Mayo-Smith WW. Outcome of 17 patients with portal venous gas detected by CT. Am J Roentgenol 1997;169(6):1535–1538.
Peloponissios N, Halkic N, Pugnale M, Jornod P, Nordback P, Meyer A, et al. Hepatic portal gas in adults: review of the literature and presentation of a consecutive series of 11 cases. Arch Surg 2003;138(12):1367–1370.
Morris MS, Gee AC, Cho SD, Limbaugh K, Underwood S, Ham B, et al. Management and outcome of pneumatosis intestinalis. Am J Surg 2008;195(5):679–682; discussion 682–3.
Schindera ST, Triller J, Vock P, Hoppe H. Detection of hepatic portal venous gas: its clinical impact and outcome. Emerg Radiol 2006;12(4):164–170.
Jakimowicz J, Stultiëns G, Smulders F. Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc 1998;12(2):129–132.
Gutt CN, Schmandra TC. Portal venous flow during CO(2) pneumoperitoneum in the rat. Surg Endosc 1999;13(9):902–905.
Schmandra TC, Kim ZG, Gutt CN. Effect of insufflation gas and intraabdominal pressure on portal venous flow during pneumoperitoneum in the rat. Surg Endosc 2001;15(4):405–408.
Nicolaus T, Buhr HJ, Kruschewski M. Is hepatic portal venous gas the writing on the wall? Zentralbl Chir 2008;133(1):76–78.
Iannitti DA, Gregg SC, Mayo-Smith WW, Tomolonis RJ, Cioffi WG, Pricolo VE. Portal venous gas detected by computed tomography: is surgery imperative? Dig Surg 2003;20(4):306–315.
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Napolitano, L., Waku, M., Costantini, R. et al. Portal vein gas due to gangrenous cholecystitis treated by a laparoscopic procedure: Report of a case. Surg Today 39, 909–912 (2009). https://doi.org/10.1007/s00595-008-3936-y
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DOI: https://doi.org/10.1007/s00595-008-3936-y