Hepatic portal venous gas with pneumatosis intestinalis secondary to mesenteric ischemia in elderly patients: Two case reports.

Content Provider	Europe PMC
Author	Wang, Minjia Song, Jia Gong, Shijin Yu, Yihua Hu, Weihang Wang, Yueben
Copyright Year	2020
Abstract	AbstractIntroduction:Hepatic portal venous gas (HPVG) is a rare imaging finding. When HPVG is accompanied with pneumatosis intestinalis (PI), the underlying cause is usually mesenteric ischemia with consequent intestinal necrosis. This combination of clinical conditions is associated with a poor prognosis. In this study, we present the cases of 2 elderly patients with HPVG and PI secondary to mesenteric ischemia.Patient concerns:In case 1, a 89-year-old male patient was admitted to intensive care unit with respiratory failure, On the fifth day of admission, he developed a high fever (39.5°C) and abdominal distension. In case 2, a 92-year-old male patient admitted to our intensive care unit and received mechanical ventilation due to acute respiratory failure. During the treatment, the patient developed gastrointestinal bleeding. On physical examination, abdominal bulging and tense abdominal walls were detected. Both patients underwent abdominal contrast-enhanced computed tomography, showed abundant HPVG with PI.Diagnoses:The patients were diagnosed as acute mesenteric ischemia, bowel necrosis, septic shock, multiple organ dysfunction syndrome based on computed tomography scan, abdominal signs, and laboratory tests.Interventions:Fluid resuscitation, high-dose vasopressors, and intravenous antibiotic therapy were given.Outcomes:Despite prompt treatment, the condition of both patients rapidly deteriorated, and the patients died shortly thereafter.Conclusion:Mesenteric ischemia is a clinical emergency. In patients with risk factors and abdominal signs, the clinical suspicion for this condition should be high. Although rare, both HPVG and PI are important radiological clues that usually indicate the presence of mesenteric ischemia with consequent intestinal necrosis.
ISSN	00257974
Journal	Medicine
Volume Number	99
PubMed Central reference number	PMC7220781
Issue Number	17
PubMed reference number	32332623
e-ISSN	15365964
DOI	10.1097/md.0000000000019810
Language	English
Publisher	Wolters Kluwer Health
Publisher Date	2020-04-01
Access Restriction	Open
Rights License	This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.
Subject Keyword	hepatic portal venous gas mesenteric ischemia pneumatosis intestinalis
Content Type	Text
Resource Type	Article
Subject	Medicine