Hepatic Portal Venous Gas: An Ill Omen or a Misleading Sign

Abstract

Hepatic portal venous gas (HPVG), a rare radiological finding, is historically considered an ominous sign with 100% mortality rates. The dictum that HPVG warrants surgical intervention is challenged in the recent literature. This is because of the identification of various causes of HVPG other than bowel gangrene. Most of these newly identified causes can be managed conservatively. However, bowel gangrene, if missed, is fatal. Hence, sound clinical judgment and accurate diagnosis based on specific clinical parameters and imaging findings are important. We present a case of a young male with tumor lysis syndrome and neutropenic sepsis. He underwent treatment for a relapse of T-cell acute lymphocytic leukemia and presented with abdominal pain and distension. Computed tomography (CT) scan showed HPVG, and the differential diagnosis was neutropenic colitis or pseudomembranous colitis, with steroid use as the probable cause. The patient was managed conservatively. The case emphasizes that the evaluation for a specific cause of HPVG is important to reduce unnecessary surgery. A succinct literature review provides the reasons for the changing mortality rates.

Keywords

necrotizing enterocolitis - bowel gangrene - leukemia

Ethics Statement

The study was performed after the approval of research protocols by the Ethics Committee of Lilavati Hospital and Research Centre in accordance with international agreements (World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects,” amended in October 2013, www.wma.net).

Informed Consent

Written informed consent was obtained from the patient involved in the study.

Author Contributions

Shruti Mehta contributed to data collection, data analysis, and preparation of the initial draft of the manuscript. Gunjan S. Desai contributed to critical revision of the manuscript for intellectual content, technical support, material support, and study supervision. Saumil Shah contributed to critical revision of the manuscript for intellectual content, technical support, material support, and study supervision. Hitesh Mehta contributed to critical revision of the manuscript for intellectual content, technical support, material support, and study supervision. Aniruddha Phadke contributed to the study concept, critical revision of the manuscript for intellectual content, administrative, technical support, material support, and study supervision.

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