Korean J Gastroenterol.  2013 Mar;61(3):170-173. 10.4166/kjg.2013.61.3.170.

A Case of Successful Treatment of Portal Venous Gas Caused by Acute Pancreatitis

  • 1Department of Internal Medicine, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea. Chg21@kwandong.ac.kr
  • 2Department of Radiology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.
  • 3Department of Surgery, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.


Hepatic portal venous gas (HPVG) has been considered a rare entity associated with a poor prognosis. Portal vein gas is most commonly caused by mesenteric ischemia but may have a variety other causes. HPVG can be associated with ischemic bowel disease, inflammatory bowel disease, intra-abdominal abscess, small bowel obstruction, acute pancreatitis, and gastric ulcer. Because of high mortality rate, most HPVG requires emergent surgical interventions and intensive medical management. We experienced a case of hepatic portal venous gas caused by acute pancreatitis and successfully treated with medical management.


Hepatic portal vein; Superior mesenteric vein; Gas; Acute pancreatitis

MeSH Terms

Acute Disease
Anti-Bacterial Agents/therapeutic use
Middle Aged
Pancreatitis/*diagnosis/drug therapy/radiography
Portal Vein/radiography
Tomography, X-Ray Computed
Vascular Diseases/*diagnosis/drug therapy/radiography
Anti-Bacterial Agents


  • Fig. 1. Acute pancreatitis with portal and superior mesenteric venous gas. (A) CT showed portal vein air (arrows) in the peripheral portion of left hepatic lobe. Loculated fluid collection (F) in the lesser sac and retroperitoneal space. Note hepatomegaly with severe fatty liver indicating alcoholic liver disease. (B) CT revealed air in the superior mesenteric vein (arrow) and swelling of the pancreas (arrowheads) with peripancreatic fluid (F).

  • Fig. 2. Follow-up CT after 2 days. CT scans showed absence of air in the portal vein (A) and superior mesenteric vein (B). Diffuse pancreatic swelling with fluid collection in the perihepatic and retroperitoneal space suggested acute pancreatitis.



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