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Song, Koo, Kang, Park, Kim, Hyun, Jung, and Lee: A Case of Necrotizing Colitis Presenting with Hepatic Portal Venous Gas and Pneumatosis Intestinalis
Case Report

Korean J Gastroenterol 2015;65(3):177-181.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.65.3.177

A Case of Necrotizing Colitis Presenting with Hepatic Portal Venous Gas and Pneumatosis Intestinalis

Jong Gyu Song, Ja Seol Koo, Hyo Sung Kang, Jin Yong Park, Seoung Young Kim, Jong Jin Hyun, Sung Woo Jung, Sang Woo Lee

Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea

Correspondence to: Ja Seol Koo, Division of Gastroenterology, Department of Internal Medicine, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 425-707, Korea. Tel: +82-31-412-5580, Fax: +82-31-412-5582, E-mail: jskoo@korea.ac.kr

Received 29 July 201411 September 2014       Accepted 16 September 2014

Copyright © 2015 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hepatic portal venous gas is a very rare radiologic sign which is characterized by gas accumulation in the portal venous circulation. Pneumatosis intestinalis is also very rare and is characterized by multiple air cysts in the serosal or submucosal layers of the gastrointestinal tract walls. These two findings are caused by various pathological conditions and can develop individually or simultaneously. The latter is clinically more significant because it is frequently related to bowel ischemia or necrosis, and represents a poor prognosis. However, prognosis is more influenced by the severity of underlying disease rather than hepatic portal venous gas or pneumatosis intestinalis itself. If bowel ischemia or necrosis is the primary cause, emergency operation is very important to improve patient's prognosis. Herein, we report a case of necrotizing colitis presenting as hepatic portal venous gas and pneumatosis intestinalis which was successfully managed by early surgery.

Keywords: Hepatic portal venous gas, Pneumatosis intestinalis

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Fig. 1.
Plain abdomen radiography. (A) Initially, no remarkable findings are present. (B) After two days, numerous air bubbles are noted in the ascending and descending colon (arrows).
kjg-65-177f1.tif
Fig. 2.
Abdominal computed tomography scan. (A) Numerous air densities are noted in the distal portal vein branches of the liver (short arrows), and gas is also seen in the extrahepatic portal vein (long arrow). (B) Gas is present within the inferior mesenteric vein (arrow). (C) Numerous air bubbles in the bowel wall are noted on descending and sigmoid colon (arrows). (D) Mild fluid collection and minimal amount of free air are observed in the left pericolic gutter (arrow).
kjg-65-177f2.tif
Fig. 3.
Gross finding. Extensive necrosis and hemorrhagic infarction are seen on the entire colon.
kjg-65-177f3.tif
Table 1.
Clinical Data of Seven Patients with Hepatic Portal Venous Gas and Pneumatosis Intestinalis Reported in Korea
Report Sex/ age (yr) Clinical features Etiology Comorbidity Diagnostic modality Treatment Outcome
Kim et al.14 M/47 Abdominal pain, vomiting, altered mentality Unknown DM, alcoholics CT Supportive Expired
Kim et al.14 M/54 Abdominal pain Peptic ulcer perforation None CT Surgery Expired
Jang and Lee15 F/55 Diarrhea, vomiting, abdominal pain Necrotizing colitis DM, HTN, ESRD CT Surgery Recovered
Park et al.16 M/53 Fever, abdominal pain Acute pancreatitis Alcoholics CT Supportive Expired
Yang et al.17 F/83 Abdominal pain, vomiting Unknown HTN CT Supportive Expired
Lee at al.18 M/53 Abdominal pain Anaerobe infection DM, HTN, ESRD CT Supportive Recovered
Yu et al.19 F/87 Altered mentality Emphysematous pyelonephritis DM CT Supportive Recovered

DM, diabetes mellitus; HTN, hypertension; ESRD, end stage renal disease.

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