Hepatic Infarction Caused by Hepatic Portal Venous Gas and Hepatic Arterial Insufficiency: Report of a Case

Abstract

Hepatic infarction is a rare disease due to dual blood supply from the hepatic artery and the portal vein. We reported a 78-year-old woman, a poorly controlled type 2 diabetes mellitus, presented with a low-grade fever for 2 days. During admission, systemic hypotension and progressive abdominal distention were noted. Abdominal ultrasonography revealed a geographically-shaped hypoechoic area and moving highly echogenic shadowing in the right lobe of the liver. Computed tomography of the abdomen demonstrated intestinal ischemia in conjunction with three rare clinical findings: pneumatosis intestinalis, hepatic portal venous gas and hepatic infarction. In this case, we believe that dual insufficiencies of the hepatic arterial and portal venous blood supply due to hepatic portal venous gas and marked systemic hypotension resulted in the hepatic infarction. This is an important clinical finding suggesting that despite the rarity of a hepatic infarction, this complication should be considered in hypotensive patients with hepatic portal venous gas.