Transient portal venous gas in upper gastrointestinal bleeding: A case report

Abstract

Portal venous gas (PVG) or hepatic portal venous gas (HPVG) is the accumulation of gas in the portal vein and its branches. HPVG may be considered as a nonspecific sign of a significant abdominal disease, ranging from potentially lethal diseases to benign conditions. Computed tomography (CT) can detect both the presence of gas and the underlying pathology. I report a 60-year-old male who presented to the emergency department with upper gastrointestinal bleeding and a high lactate level in the blood test. Because of the unknown etiology for the elevated lactate, a CT scan of the abdomen was taken, which showed that he developed intra-and extra-hepatic portal venous gas as well as in the portomesentric-portosystemic collaterals without any signs of mesenteric ischemia. The patient was treated conservatively and the HPVG completely resolved after a few days. Overall, physicians must be aware that prognosis is related to the pathology itself and is not influenced by the presence of PVG. HPVG can be caused by several benign conditions that do not necessarily require urgent exploratory laparotomy.

Keywords

• HPVG, hepatic portal venous gas
• PVG, portal venous gas
• CT, computed tomography
• UGB, upper gastrointestinal bleeding
• IBD, inflammatory bowel disease