Portal vein gas, a changing clinical entity. Report of 7 patients and review of the literature
J. J. Hong, D. Gadaleta, P. Rossi, J. Esquivel and J. M. Davis
Department of Surgery, New York Hospital-Cornell Medical Center, New York, USA.
OBJECTIVE: To assess the clinical significance of portal vein gas (PVG)
demonstrated by computed tomography (CT). DESIGN: Review of medical
records. SETTING: Three network-affiliated hospitals providing both primary
community-based and tertiary services. METHODS: Review of diagnosis,
clinical circumstances, and significance of PVG in 7 patients detected by
CT during a 3-year period in 3 affiliated hospitals. RESULTS: Four of 7
patients underwent laparotomy; 1 patient refused surgery. Two patients were
treated with intravenous antibiotics only and had uneventful clinical
courses. Of the 3 patients who died, 1 refused and 2 underwent laparotomy.
CONCLUSIONS: This series indicates that more sensitive imaging and more
widespread use of endoscopic retrograde cholangiopancreatography,
colonoscopy, and liver transplantation have changed the clinical
presentation of PVG; PVG may be found in various clinical settings that do
not mandate laparotomy; and the significance of PVG must be derived from
the clinical context of the individual patient.