A rare case of portal pneumatosis. What are the therapeutic resources?

Abstract

Hepatic portal vein gas was first describes in 1955 by Wolf and Evans. It is a rare and severe condition that in 80% of cases leads to patient’s death. Most common causes are :necrotizing enterocolitis, mesenteric ischemia, sepsis , intestinal perforation. A 73-year old male patient underwent an elective rectal amputation for anal adenocarcinoma, after radiotherapy.In the 12th postoperative day the clinical state of the patient degraded, with onset of acute abdominal pain and fever.A CT scan and ultrasound examination showed the presence of hepatic portal venous gas with of pneumatosis intestinalis and an abcess in the pelvic region.Intraoperatively, two small perforations were found at the distal jejunun with no ischemia or necrosis. An ileostomy was performed, with drainage of the peritoneal cavity.Post-operatively the patient was stabilized and was eventually discharged in stable condition .The presence of hepatic portal venous gas with the of pneumatosis intestinalis is most frequently associated with ischemic bowel, ileus, diverticulitis, gastric distention, inflammatory bowel disease (IBD), hypotension post dialysis treatment, decompression sickness, trauma and iatrogenic causes from instrumentation and recent surgery.