Portal venous gas has mainly been studied in pediatrics and seen in cases of necrotizing enterocolitis. It is a rare finding in adults and is typically associated with underlying intestinal ischemia or other malignant intra-abdominal pathology. Portal venous gas is seen more readily on ultrasound compared to radiographs in both pediatric and adult patients. Findings include lucencies extending to the periphery of the liver, echogenic bubbles flowing centrifugally throughout the portal venous system, and bidirectional spikes interrupting the monophasic portal venous waveform on spectral analysis.
We present a case of a 36-year-old female who presented with abdominal pain. She had findings consistent with portal venous gas on point-of-care ultrasound, prompting computed tomography of her abdomen and surgical consultation. She was ultimately found to have cecal ischemia from cecal volvulus, had surgical resection and anastomosis, and was able to be discharged from the hospital following recovery.
Why Should an Emergency Physician Be Aware of This?
With the ever-increasing use of point-of-care ultrasound, emergency physicians should be aware of the findings consistent with portal venous gas as well as its implications. Emergency physicians should know portal venous gas is associated with intestinal ischemia and other malignant pathologies and should prompt more advanced imaging or surgical consultation when observed. Emergency physicians should also understand the distinctions between portal venous gas and pneumobilia found on point-of-care ultrasound, given that portal venous gas is typically a malignant finding and pneumobilia is most frequently benign.
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- Evaluation of portal venous gas detected by ultrasound examination for diagnosis of necrotizing enterocolitis.Arch Dis Child Fetal Neonatal Ed. 2009; 94: 183-187
- Survival after ultrasonographic demonstration of portal venous gas due to mesenteric artery occlusion.Postgrad Med J. 1990; 66: 137-139
- Hepatic-portal venous gas in adults: etiology, pathophysiology and clinical significance.Ann Surg. 1978; 187: 281-287
- Ultrasound in detection of portal venous gas in adults.Gastrointest Radiol. 1991; 16: 35-37
- Distinguishing between hepatic portal vein gas and pneumobilia.Liver Transpl. 2007; 13: 1476
- Hepatic portal venous gas: physiopathology, etiology, prognosis, and treatment.World J Gastroenterol. 2009; 15: 3585-3590
- Sonographic demonstration of septicaemia with gas-forming organisms after liver transplantation.Clin Radiol. 1991; 43: 397-399
- Clinical features and management of hepatic portal venous gas: four case reports and cumulative review of the literature.Arch Surg. 2001; 136: 1410-1414
- Intermittent hepatic portal vein gas complicating diverticulitis—a case report and literature review.Int J Colorectal Dis. 2007; 22: 1395-1399
- Extensive portal venous gas: unlikely etiology and outcome.Int J Surg Case Rep. 2015; 8: 134-136
- Portal venous gas after hepatic transplantation: sonographic detection and clinical significance.AJR Am J Roentgenol. 1989; 153: 1203-1205
Published online: December 13, 2019
Accepted: October 27, 2019
Received in revised form: October 13, 2019
Received: June 22, 2019
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