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Arico FM, Buemi F, Pitrone P, Giardina C, Trimarchi R, Borruto F, Doria S, Turiaco C, Caloggero S. Hepatic Portal Venous Gas (HPVG) after Ingestion of Chlorine Bleach: A Transient Phenomenon. Diagnostics (Basel) 2023; 13:3615. [PMID: 38132200 PMCID: PMC10742429 DOI: 10.3390/diagnostics13243615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
We present a case involving a 32-year-old man who ingested chlorine bleach with self-defeating intent. The ingestion of bleach can lead to a wide range of consequences, from mild mucosal burns to severe complications, rarely resulting in death. This case highlights the association between chlorine bleach ingestion and the development of hepatic portal venous gas (HPVG), a radiological finding traditionally thought to carry poor prognoses. The HPVG in this case resolved spontaneously within 24 h with conservative management, indicating its transient nature. The exact pathophysiological mechanisms responsible for HPVG after the ingestion of toxic substances .remain only partially understood. One hypothesis suggests that extensive damage to the gastrointestinal wall caused by caustic agent may allow enteric gas to enter the portal system. While HPVG after toxic ingestion is often transient, its consequences and potential risks should be carefully considered. Hyperbaric oxygen therapy is suggested in cases with neurological symptoms. In conclusion, HPVG is not a specific disease but rather a manifestation of various underlying factors, and its development in the context of chlorine bleach ingestion represents an additional insight to its understanding. It can be associated with severe medical conditions, but it is also found in less severe cases that can be managed conservatively.
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Affiliation(s)
- Francesco M. Arico
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | - Francesco Buemi
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | - Pietro Pitrone
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | | | - Renato Trimarchi
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Department of Radiology, ASST Bergamo Ovest, Ospedale Treviglio-Caravaggio, 24047 Treviglio, BG, Italy
| | - Flavia Borruto
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | - Sarah Doria
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | - Cristina Turiaco
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
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Symeonidis D, Bompou E, Samara AA, Kissa L, Paraskeua I, Tsikrika A, Tepetes K. White spirit poisoning: An unusual cause of hepatic portal venous gas. Radiol Case Rep 2022; 17:4717-4722. [PMID: 36212755 PMCID: PMC9535280 DOI: 10.1016/j.radcr.2022.08.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/05/2022] Open
Abstract
Traditionally, the presence of air within the hepatic portal venous system has been considered a rather ominous sign as it has been associated with conditions of increased associated morbidity and mortality such as bowel ischemia and intraabdominal sepsis. However, benign conditions, not requiring any particular intervention, have been implemented in the etiology, as well. In the present report, we present the case of the accidental ingestion of white spirit as a rather unusual cause of hepatic portal vein gas. A 32-year-old, otherwise healthy, male was admitted to the emergency department following the accidental ingestion of a "sip," approximately 15 ml, of white spirit. The patient was complaining of nausea and upper abdominal pain that started soon after the ingestion of caustic agent. An imaging investigation with a computed tomography scan (CT) of the abdomen revealed the presence of hepatic portal vein gas along with a diffuse edema of the gastric wall at the site of the lesser curvature. A follow-up CT, 2 days after the admission, revealed no evidence of hepatic portal venous gas. Based on the patient's good general condition, an expectant management was decided. No intervention was required, oral feeding was recommenced after 6 days of fasting and the patient was discharged 8 days after the admission. Hepatic portal venous gas is a very impressive imaging finding with remarkably diverse etiology and prognostic correspondence. Irrespective of the cause, an approach of managing patients with hepatic portal venous gas according to their clinical condition appears reasonable.
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Affiliation(s)
- Dimitrios Symeonidis
- Department of Surgery, University Hospital of Larissa, Biopolis, Mezourlo, 41110, Larissa, Greece
| | - Effrosyni Bompou
- Department of Surgery, University Hospital of Larissa, Biopolis, Mezourlo, 41110, Larissa, Greece
| | - Athina A. Samara
- Department of Surgery, University Hospital of Larissa, Biopolis, Mezourlo, 41110, Larissa, Greece
| | - Labrini Kissa
- Department of Surgery, University Hospital of Larissa, Biopolis, Mezourlo, 41110, Larissa, Greece
| | - Ismini Paraskeua
- Department of Surgery, University Hospital of Larissa, Biopolis, Mezourlo, 41110, Larissa, Greece
| | - Alexandra Tsikrika
- Department of Radiology, University Hospital of Larissa, Mezourlo, Larissa, Greece
| | - Konstantinos Tepetes
- Department of Surgery, University Hospital of Larissa, Biopolis, Mezourlo, 41110, Larissa, Greece
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Redmond CE, Healy GM, Kelly BS, McCann J. Re: Treat the patient or radiology? Free intraperitoneal gas in clinically well patients with perforated diverticulitis. ANZ J Surg 2017; 87:102-103. [PMID: 28156066 DOI: 10.1111/ans.13836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Ciaran E Redmond
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Gerard M Healy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Brendan S Kelly
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Jeffrey McCann
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
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Takahashi F, Tominaga K, Hiraishi H. Hepatic Portal Venous Gas Caused by Endoscopic Balloon Dilatation for Crohn's Stenosis. Clin Gastroenterol Hepatol 2016; 14:A23-A24. [PMID: 27581065 DOI: 10.1016/j.cgh.2016.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Fumiaki Takahashi
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hideyuki Hiraishi
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Tochigi, Japan
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Sawano T, Nemoto T, Tsubokura M, Leppold C, Ozaki A, Kato S, Kanazawa Y. Asymptomatic hepatic portal venous gas with gastric emphysema as a chronic complication of gastrostomy tube placement: a case report. J Med Case Rep 2016; 10:234. [PMID: 27557875 PMCID: PMC4997736 DOI: 10.1186/s13256-016-1037-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/12/2016] [Indexed: 12/13/2022] Open
Abstract
Background Percutaneous endoscopic gastrostomy feeding is widely used as a route for enteral feeding for patients with impaired swallowing ability, particularly in older patients. Hepatic portal venous gas is a condition that may arise from several causes. Hepatic portal venous gas that develops after an endoscopic procedure is generally reported to be nonfatal, yet there is little information available concerning the characteristics of hepatic portal venous gas as a chronic complication of percutaneous endoscopic gastrostomy feeding. Case presentation We experienced a case of hepatic portal venous gas that happened to be detected in an 81-year-old Japanese man with long-term percutaneous endoscopic gastrostomy use who was admitted to our hospital with aspiration pneumonia. While aspiration pneumonia was treated with antibiotics and suspension of tube feedings, he recovered from hepatic portal venous gas without any treatment. Conclusions The presence of a percutaneous endoscopic gastrostomy tube may have induced hepatic portal venous gas through a mechanism in which vomiting led to increased abdominal pressure and eventually gastric emphysema. This case suggests that hepatic portal venous gas without any signs of bowel ischemia or emphysematous gastritis can resolve without treatment, which is a finding that could be helpful for clinicians who deal with those supported by percutaneous endoscopic gastrostomy feeding.
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Affiliation(s)
- Toyoaki Sawano
- Department of Surgery, Minamisoma Municipal General Hospital, 54-6 Takamicho 2 chome, Haramachi, Minamisoma, Fukushima, 975-0033, Japan.
| | - Tsuyoshi Nemoto
- Department of Home Medical Care, Minamisoma Municipal General Hospital, Fukushima, 975-0033, Japan
| | - Masaharu Tsubokura
- Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, University of Tokyo, Tokyo, 108-0071, Japan
| | - Claire Leppold
- Department of Research, Minamisoma Municipal General Hospital, Fukushima, 975-0033, Japan
| | - Akihiko Ozaki
- Department of Surgery, Minamisoma Municipal General Hospital, 54-6 Takamicho 2 chome, Haramachi, Minamisoma, Fukushima, 975-0033, Japan
| | - Shigeaki Kato
- Department of Internal Medicine, Soma Central Hospital, Fukushima, 976-0016, Japan
| | - Yukio Kanazawa
- Department of Gastroenterology, Minamisoma Municipal General Hospital, Fukushima, 975-0033, Japan
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Yamada T, Kan H, Matsumoto S, Machida T, Koizumi M, Shinji S, Matsuda A, Yamagishi A, Yokoyama Y, Uchida E. A Case of Portal Venous Gas after Rectal Surgery without Anastomotic Leakage or Bowel Necrosis. J NIPPON MED SCH 2015; 82:202-5. [PMID: 26328797 DOI: 10.1272/jnms.82.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Portal venous gas has traditionally been considered an indicator of a poor prognosis due to bowel necrosis. Portal venous gas has recently been detected in patients with various clinical conditions, such as Crohn's disease, chemotherapy, and blunt abdominal injury without bowel necrosis. We herein report the first case of a patient with rectal cancer in whom portal venous gas developed after low anterior resection without anastomotic leakage or bowel necrosis. A 66-year-old man who had undergone low anterior resection started having severe diarrhea the day after the operation. A fever was present for 2 days after the operation but resolved on postoperative day 3. The patient complained of abdominal pain 5 days postoperatively. Computed tomography showed portal venous gas. Emergency open laparotomy was performed, but only limited ascites fluid without leakage or bowel necrosis was found. We irrigated the abdominal cavity and performed an ileostomy with insertion of a drainage tube in the rectovesical pouch. Only serous ascites was discharged through the drainage tube. The portal venous gas disappeared 3 days after the second operation. The patient was discharged in good condition 21 days after the first operation. Portal venous gas can develop after rectal surgery without anastomotic leakage or bowel necrosis. Conservative treatment is reasonable for patients without signs of bowel necrosis or panperitonitis. However, patients with portal venous gas must be carefully observed because portal venous gas may be life threatening.
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Affiliation(s)
- Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
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Sadatomo A, Koinuma K, Kanamaru R, Miyakura Y, Horie H, Lefor AT, Yasuda Y. Hepatic portal venous gas after endoscopy in a patient with anastomotic obstruction. World J Gastrointest Surg 2015; 7:21-24. [PMID: 25722798 PMCID: PMC4325281 DOI: 10.4240/wjgs.v7.i2.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 12/01/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
A 72-year-old male underwent a laparoscopic low anterior resection for advanced rectal cancer. A diverting loop ileostomy was constructed due to an anastomotic leak five days postoperatively. Nine months later, colonoscopy performed through the stoma showed complete anastomotic obstruction. The mucosa of the proximal sigmoid colon was atrophic and whitish. Ten days after the colonoscopy, the patient presented in shock with abdominal pain. Abdominal computed tomography scan showed hepatic portal venous gas (HPVG) and a dilated left colon. HPVG induced by obstructive colitis was diagnosed and a transverse colostomy performed emergently. His subsequent hospital course was unremarkable. Rectal anastomosis with diverting ileostomy is often performed in patients with low rectal cancers. In patients with anastomotic obstruction or severe stenosis, colonoscopy through diverting stoma should be avoided. Emergent operation to decompress the obstructed proximal colon is necessary in patients with a blind intestinal loop accompanied by HPVG.
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Lee CG, Kang HW, Song MK, Kim JH, Lee JK, Lim YJ, Koh MS, Lee JH. A case of hepatic portal venous gas as a complication of endoscopic balloon dilatation. J Korean Med Sci 2011; 26:1108-10. [PMID: 21860565 PMCID: PMC3154350 DOI: 10.3346/jkms.2011.26.8.1108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 06/21/2011] [Indexed: 12/28/2022] Open
Abstract
The development of hepatic portal venous gas (HPVG) is rare but it might be associated with serious disease and poor clinical outcome. Recently, several iatrogenic causes of HPVG have been reported. HPVG as a complication of endoscopic balloon dilatation is a previously unreported event. We experienced a case of HPVG after endoscopic balloon dilatation in a 31 yr-old man with pyloric stricture due to corrosive acids ingestion. The patient was treated conservatively with fluid resuscitation, antibiotics and Levin tube with natural drainage. Five days later, the follow-up CT scan showed spontaneous resolution of HPVG. This case reminded us the clinical importance and management strategy of HPVG. We report here a case of iatrogenic HPVG with a review of relevant literature.
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Affiliation(s)
- Chang Geun Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Seoul, Korea
| | - Hyoun Woo Kang
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Seoul, Korea
| | - Min Keun Song
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Seoul, Korea
| | - Jae Hak Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Seoul, Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Seoul, Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Seoul, Korea
| | - Moon-Soo Koh
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Seoul, Korea
| | - Jin Ho Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Seoul, Korea
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Abboud B, El Hachem J, Yazbeck T, Doumit C, Hechtman HB. Hepatic portal venous gas: physiopathology, etiology, prognosis and treatment. World J Gastroenterol 2009; 15:3585-3590. [PMID: 19653334 PMCID: PMC2721230 DOI: 10.3748/wjg.15.3585] [Citation(s) in RCA: 177] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Revised: 07/07/2009] [Accepted: 07/14/2009] [Indexed: 02/06/2023] Open
Abstract
Hepatic portal venous gas (HPVG), an ominous radiologic sign, is associated in some cases with a severe underlying abdominal disease requiring urgent operative intervention. HPVG has been reported with increasing frequency in medical literature and usually accompanies severe or lethal conditions. The diagnosis of HPVG is usually made by plain abdominal radiography, sonography, color Doppler flow imaging or computed tomography (CT) scan. Currently, the increased use of CT scan and ultrasound in the inpatient setting allows early and highly sensitive detection of such severe illnesses and also the recognition of an increasing number of benign and non-life threatening causes of HPVG. HPVG is not by itself a surgical indication and the treatment depends mainly on the underlying disease. The prognosis is related to the pathology itself and is not influenced by the presence of HPVG. Based on a review of the literature, we discuss in this paper the pathophysiology, risk factors, radiographic findings, management, and prognosis of pathologies associated with HPVG.
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Hussain A, Mahmood H, El-Hasani S. Portal vein gas in emergency surgery. World J Emerg Surg 2008; 3:21. [PMID: 18637169 PMCID: PMC2490689 DOI: 10.1186/1749-7922-3-21] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 07/17/2008] [Indexed: 12/22/2022] Open
Abstract
Background Portal vein gas is an ominous radiological sign, which indicates a serious gastrointestinal problem in the majority of patients. Many causes have been identified and the most important was bowel ischemia and mesenteric vascular accident. The presentation of patients is varied and the diagnosis of the underlying problem depends mainly on the radiological findings and clinical signs. The aim of this article is to show the clinical importance of portal vein gas and its management in emergency surgery. Methods A computerised search was made of the Medline for publications discussing portal vein gas through March 2008. Sixty articles were identified and selected for this review because of their relevance. These articles cover a period from 1975–2008. Results Two hundreds and seventy-five patients with gas in the portal venous system were reported. The commonest cause for portal vein gas was bowel ischemia and mesenteric vascular pathology (61.44%). This was followed by inflammation of the gastrointestinal tract (16.26%), obstruction and dilatation (9.03%), sepsis (6.6%), iatrogenic injury and trauma (3.01%) and cancer (1.8%). Idiopathic portal vein gas was also reported (1.8%). Conclusion Portal vein gas is a diagnostic sign, which indicates a serious intra-abdominal pathology requiring emergency surgery in the majority of patients. Portal vein gas due to simple and benign cause can be treated conservatively. Correlation between clinical and diagnostic findings is important to set the management plan.
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Affiliation(s)
- Abdulzahra Hussain
- General surgery department, Princess Royal University Hospital, Greater London, UK.
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