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Review of the Literature and Presentation of a Consecutive Series of 11 Cases

Nicolas Peloponissios, MD; Nermin Halkic, MD; Mauro Pugnale, MD; Philippe Jornod, MD; Petter Nordback, MD; Alain Meyer, MD; Michel Gillet, MD

Arch Surg. 2003;138:1367-1370.

Background  Hepatic portal venous gas (HPVG) in adults is a rare entity. The underlying pathologic condition is usually an intestinal ischemia, but it has been reported in association with a variety of conditions.

Hypothesis  Miscomprehension of the underlying pathologic conditions has led to some confusion in the literature concerning its etiology, diagnostic methods, and clinical consequences.

Setting  Centre Hospitalier et Universitaire Vaudois, Lausanne, Switzerland, and District Hospital of Morges, Morges, Switzerland.

Method  Between February 1, 1995, and May 30, 2000, eleven cases of HPVG were treated. These cases were retrospectively reviewed, together with a review of the literature to define the clinical significance of HPVG, the role of the computed tomographic scan, and the necessity of performing systematic emergency exploratory surgery.

Results  Two groups have to be distinguished—those who have HPVG with associated pneumatosis intestinalis and those who have HPVG without associated pneumatosis intestinalis. When associated with pneumatosis intestinalis, the cause is usually an intestinal ischemia and in a symptomatic patient it justifies systematic exploratory surgery. An abdominal computed tomographic scan including lung window settings to better identify air in the bowel wall will distinguish between these 2 groups. Pneumatosis intestinalis and HPVG due to bowel ischemia do not allow prediction of the severity of bowel wall damage.

Conclusions  The cause of HPVG without pneumatosis intestinalis is variable. Good knowledge of the possible causes combined with the clinical picture and the abdominal computed tomographic scan is required to correctly identify the underlying cause of HPVG and to avoid unnecessary surgery.

From the Departments of Surgery (Drs Peloponissios, Halkic, Nordback, and Gillet), Radiology (Dr Pugnale), and Gastroenterology (Dr Jornod), Centre Hospitalier et Universitaire Vaudois, Lausanne, Switzerland; and the Department of Surgery, District Hospital of Morges, Morges, Switzerland (Dr Meyer).

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