Abstract
Aeroportia is the presence of gas in the portal vein. It is considered an ominous radiological sign with poor outcomes. Historically, it was associated with bowel necrosis, and surgery was mandated in all cases. Herein, we present a challenging case of portal venous gas and its management.An 87-year-old male patient, with multiple co-morbidities, presented with abdominal pain. The computerized tomography (CT) scan showed extensive portal venous gas without evidence of bowel ischemia. Initially, he was managed conservatively, but his clinical condition deteriorated. So, an exploratory laparotomy was performed which revealed multiple superficial splenic abscesses covering the surface of the spleen and a pale segment of jejunum with questionable viability. Splenectomy was performed and second-look laparotomy was planned to assess the small bowel viability. Second-look laparotomy revealed dusky discoloration of 30 cm jejunal segment. The affected segment was resected. The patient improved after surgery and was discharged home.In conclusion, aeroportia (portal venous gas) is a radiological entity. The clinical condition of the patient must be kept in consideration to manage the patients optimally. However, if the patient deteriorates, a high index of suspicion for mesenteric ischemia and early surgical intervention are the keys to save the patients’ life.
Highlights
Portal venous gas (PVG) and pneumatosis intestinalis (PI) is considered an ominous radiological finding
Portal venous gas (PVG) was first reported in neonatal abdominal radiographs by Wolfe et al in 1955 [4], whereas in adults, it was reported by Susman et al in 1960 [5]
Initially it was associated with grim prognosis because only plain radiographs were used for imaging, with the advancements in diagnostic radiology and as the use of multidetector computerized tomography (CT) scan became widespread, the outcome of PVG has changed
Summary
Portal venous gas (PVG) and pneumatosis intestinalis (PI) is considered an ominous radiological finding. An 87-year-old male of Middle Eastern descent, known to have multiple co-morbidities, presented to the emergency department with complaints of central abdominal, colicky pain which was mild to moderate in severity, non-radiating, and non-migratory It was associated with loose stools for four days. Examination revealed a conscious and oriented elderly male, lying in his bed with a bit of discomfort He had dry oral mucosa and his urine was concentrated indicating dehydration. Abdominal examination showed no skin changes, visible scars, ecchymosis, or palpable masses. His histopathology showed the spleen with congested red pulp covered with thick white exudate. The intestinal segment showed extensive hemorrhagic infarction and necrosis of mucosa, consistent with ischemia without any vascular occlusion. He was followed up in the clinic after two weeks and showed remarkable full recovery
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