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. 1978 Mar;187(3):281–287. doi: 10.1097/00000658-197803000-00012

Hepatic--portal venous gas in adults: etiology, pathophysiology and clinical significance.

P R Liebman, M T Patten, J Manny, J R Benfield, H B Hechtman
PMCID: PMC1396434  PMID: 637584

Abstract

The roentgenographic finding hepatic--portal venous gas (HPVG) has been reported extensively in the pediatric and radiology literature. The surgical implications and clinical significance have yet to be fully defined. This study reviews the 60 reported cases in the literature and adds four new cases. HPVG appears as a branching radiolucency extending to within 2 cm of the liver capsule. HPVG is associated with necrotic bowel (72%), ulcerative colitis (8%), intra abdominal abscess (6%), small bowel obstruction (3%), and gastric ulcer (3%). Mucosal damage, bowel distention and sepsis predispose to HPVG. The current mortality rate of 75% represents an improvement from previous experience. Analysis of survivors indicates that the finding of HPVG requires urgent surgical exploration except when it is observed in patients with stable ulcerative colitis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnon R. G., Fishbein J. F. Portal venous gas in the pediatric age group. Review of the literature and report of twelve new cases. J Pediatr. 1971 Aug;79(2):255–259. doi: 10.1016/s0022-3476(71)80110-5. [DOI] [PubMed] [Google Scholar]
  2. BARRETT A. F. Gas in the portal vein. Diagnostic value in intestinal gangrene. Clin Symp. 1962 Apr;13:92–95. doi: 10.1016/s0009-9260(62)80026-9. [DOI] [PubMed] [Google Scholar]
  3. Berne T. V., Meyers H. I., Donovan A. J. Gas in the portal vein of adults with necrotizing enteropathy. Am J Surg. 1970 Aug;120(2):203–209. doi: 10.1016/s0002-9610(70)80112-x. [DOI] [PubMed] [Google Scholar]
  4. Dell J. M., Jr Gas in the portal vein. Am J Roentgenol Radium Ther Nucl Med. 1967 Jun;100(2):424–425. doi: 10.2214/ajr.100.2.424. [DOI] [PubMed] [Google Scholar]
  5. EDWARDS A. M., COSTOPOULOUS L. B., BELL H. E. PRIMARY MACROGLOBULINEMIA: DEATH DUE TO MESENTERIC VASCULAR OCCLUSION WITH GAS IN THE PORTAL VENOUS SYSTEM. Can Med Assoc J. 1964 Dec 19;91:1300–1306. [PMC free article] [PubMed] [Google Scholar]
  6. Edwards A. M., Michalyshyn B., Costopoulos L. B. Survival following gas in the portal venous system: a report of two cases. Can Med Assoc J. 1967 Oct 21;97(17):1029–1031. [PMC free article] [PubMed] [Google Scholar]
  7. Fink D. W., Boyden F. M. Gas in the portal veins. A report of two cases due to ingestion of corrosive substances. Radiology. 1966 Oct;87(4):741–743. doi: 10.1148/87.4.741. [DOI] [PubMed] [Google Scholar]
  8. Fred H. L., Mayhall C. G., Harle T. S. Hepatic portal venous gas. A review and report on six new cases. Am J Med. 1968 Apr;44(4):557–565. doi: 10.1016/0002-9343(68)90056-9. [DOI] [PubMed] [Google Scholar]
  9. GUYER P. B., GRAINGER K. Gas in the portal vein. A report of two cases. Br J Radiol. 1963 May;36:379–381. doi: 10.1259/0007-1285-36-425-379. [DOI] [PubMed] [Google Scholar]
  10. Giustra P. E., Killoran P. J., Morse E. K. Postoperative bowel necrosis with portal vein gas. Am J Gastroenterol. 1975 Aug;64(2):140–143. [PubMed] [Google Scholar]
  11. Goldstein W. B., Cusmano J. V., Gallagher J. J., Hemley S. Portal vein gas. A case report with survival. Am J Roentgenol Radium Ther Nucl Med. 1966 May;97(1):220–222. doi: 10.2214/ajr.97.1.220. [DOI] [PubMed] [Google Scholar]
  12. Graham G. A., Bernstein R. B., Gronner A. T. Gas in the portal and inferior mesenteric veins caused by diverticulitis of the sigmoid colon. Report of a case with survival. Radiology. 1975 Mar;114(3):601–602. doi: 10.1148/114.3.601. [DOI] [PubMed] [Google Scholar]
  13. Graham N. G. Gas in the portal vein in association with a pelvic abscess. Br Med J. 1967 Jul 29;3(5560):288–288. doi: 10.1136/bmj.3.5560.288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kees C. J., Hester C. L., Jr Portal vein gas following barium enema examination. Radiology. 1972 Mar;102(3):525–526. doi: 10.1148/102.3.525. [DOI] [PubMed] [Google Scholar]
  15. LAZAR H. P. SURVIVAL FOLLOWING PORTAL VENOUS AIR EMBOLIZATION: REPORT OF A CASE. Am J Dig Dis. 1965 Mar;10:259–264. doi: 10.1007/BF02233756. [DOI] [PubMed] [Google Scholar]
  16. MCCANDLESS R. G. PORTAL VEIN GAS: A GRAVE PROGNOSTIC SIGN. Am J Roentgenol Radium Ther Nucl Med. 1964 Nov;92:1162–1165. [PubMed] [Google Scholar]
  17. MIZRAHI A., BARLOW O., BERDON W., BLANC W. A., SILVERMAN W. A. NECROTIZING ENTEROCOLITIS IN PREMATURE INFANTS. J Pediatr. 1965 Apr;66:697–705. doi: 10.1016/s0022-3476(65)80003-8. [DOI] [PubMed] [Google Scholar]
  18. Musa B. U. Intestinal infarction without mesenteric vascular occlusion. A report of 31 cses. Ann Intern Med. 1965 Nov;63(5):783–792. doi: 10.7326/0003-4819-63-5-783. [DOI] [PubMed] [Google Scholar]
  19. Paciulli J., Jacobson G. Survival following roentgenographic demonstration of gas in the hepatic portal venous system. Am J Roentgenol Radium Ther Nucl Med. 1967 Mar;99(3):629–631. doi: 10.2214/ajr.99.3.629. [DOI] [PubMed] [Google Scholar]
  20. SCHORR S. SMALL-INTESTINAL INTRAMURAL AIR. Radiology. 1963 Aug;81:285–287. doi: 10.1148/81.2.285. [DOI] [PubMed] [Google Scholar]
  21. STEWART J. O. Portal gas embolism: a prognostic sign in mesenteric vascular occlusion. Br Med J. 1963 May 18;1(5341):1328–1329. doi: 10.1136/bmj.1.5341.1310-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. SUSMAN N., SENTURIA H. R. Gas embolization of the portal venous system. Am J Roentgenol Radium Ther Nucl Med. 1960 May;83:847–850. [PubMed] [Google Scholar]
  23. Sachs D., Pogue W. Pneumoportogram in idiopathic intestinal necrosis. Am J Surg. 1966 Feb;111(2):269–271. doi: 10.1016/0002-9610(66)90257-1. [DOI] [PubMed] [Google Scholar]
  24. Scott J. R., Miller W. T., Urso M., Stadalnik R. C. Acute mesenteric infarction. Am J Roentgenol Radium Ther Nucl Med. 1971 Oct;113(2):269–279. doi: 10.2214/ajr.113.2.269. [DOI] [PubMed] [Google Scholar]
  25. Shaw A., Cooperman A., Fusco J. Gas embolism produced by hydrogen peroxide. N Engl J Med. 1967 Aug 3;277(5):238–241. doi: 10.1056/NEJM196708032770504. [DOI] [PubMed] [Google Scholar]
  26. Sheiner N. M., Palayew M. J., Sedlezky I. Gas in the portal vein: a report of two cases. Can Med Assoc J. 1966 Sep 17;95(12):611–615. [PMC free article] [PubMed] [Google Scholar]
  27. Sibbald W. J., Sweeney J. P., Inwood M. J. Portal venous gas (PVG) as an indication for heparinization. Am J Surg. 1972 Nov;124(5):690–693. doi: 10.1016/0002-9610(72)90117-1. [DOI] [PubMed] [Google Scholar]
  28. Speer C. S., Carlson D. H. Portal venous air with survival in ulcerative colitis: report of a case. Dis Colon Rectum. 1972 Nov-Dec;15(6):453–458. doi: 10.1007/BF02642654. [DOI] [PubMed] [Google Scholar]
  29. Swaim T. J., Gerald B. Hepatic portal venous gas in infants without subsequent death. Radiology. 1970 Feb;94(2):343–345. doi: 10.1148/94.2.343. [DOI] [PubMed] [Google Scholar]
  30. Tedesco F. J., Stanley R. J. Hepatic portal vein gas without bowel infarction or necrosis. Gastroenterology. 1975 Jul;69(1):240–243. [PubMed] [Google Scholar]
  31. Tomchik F. S., Wittenberg J., Ottinger L. W. The roentgenographic spectrum of bowel infarction. Radiology. 1970 Aug;96(2):249–260. doi: 10.1148/96.2.249. [DOI] [PubMed] [Google Scholar]
  32. WIOT J. F., FELSON B. Gas in the portal venous system. Am J Roentgenol Radium Ther Nucl Med. 1961 Nov;86:920–929. [PubMed] [Google Scholar]
  33. WOLFE J. N., EVANS W. A. 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 Sep;74(3):486–488. [PubMed] [Google Scholar]
  34. Weinstein G. E., Weiner M., Schwartz M. Portal vein gas. Am J Gastroenterol. 1968 May;49(5):425–429. [PubMed] [Google Scholar]

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