Korean J Gastroenterol.  2015 Mar;65(3):177-181. 10.4166/kjg.2015.65.3.177.

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

• Song JG
• Koo JS
• Kang HS
• Park JY
• Kim SY
• Hyun JJ
• Jung SW
• Lee SW

• KMID: 2373204
• DOI: http://doi.org/10.4166/kjg.2015.65.3.177

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.

Keyword

Hepatic portal venous gas; Pneumatosis intestinalis

MeSH Terms

Colitis/complications/*diagnosis/surgery
Humans
Intestinal Perforation
Male
Middle Aged
Necrosis
Pneumatosis Cystoides Intestinalis/complications/*diagnosis
Portal Vein
Radiography, Abdominal
Tomography, X-Ray Computed

Figure

• 

  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).

• 

  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).

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  Fig. 3. Gross finding. Extensive necrosis and hemorrhagic infarction are seen on the entire colon.

Reference

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