Abstract

Clinical Image

Exceptional intraoperative aspects of mesenteric venous gas

Wael Ferjaoui*, Mohamed Hajri, Aziz Atallah, Rached Bayar, Dhouha Bacha and Mohamed Tahar Khalfallah

Published: 08 September, 2020 | Volume 4 - Issue 1 | Pages: 050-051

A 73-year-old female patient presented to the emergency department with a 3-day history of acute abdominal pain and diarrhea. She had also a history of hypertension, type 2 diabetes mellitus and hypercholesterolemia. Physical examination revealed examination a generalized abdominal tenderness with an important abdominal distension, with a body temperature of 37.5°, a pulse rate of 115 bpm and a blood pressure of 105/65 mmHg. Laboratory data showed white blood cells at 15.500/mm³, C-reactive protein at 155 mg/l, hemoglobin at 12.3 g/dl and creatinine at 105 µmol/l. Chest radiography was normal. Contrast enhanced CT of the abdomen revealed hepatic portal venous gas with diffuse gas accumulation in the branches of the superior mesenteric vein, gaseous distention of the small bowel with reduced enhancement of the bowel wall (Figure 1). Additionally, an atheromatous obstruction was observed in the superior mesenteric artery at 4cm from its origin (Figure 2). Emergency surgery was decided.

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References

  1. Abboud B, El Hachem J, Yazbeck T, Doumit C. Hepatic portal venous gas: physiopathology, etiology, prognosis and treatment. World J Gastroenterol. 2009; 15: 3585-3590. PubMed: https://pubmed.ncbi.nlm.nih.gov/19653334/
  2. Chen H, Zhan S, Deng Q, Hong C, Chen J, et al. Hepatic portal venous gas associated with bowel necrosis: report of one case and literature review. Digestive Med Res. 2020; 3: http://dmr.amegroups.com/article/view/5690
  3. Nelson AL, Millington TM, Sahani D, Chung RT, Bauer C, et al. Hepatic portal venous gas: the ABCs of management. Arc Surg. 2009; 144: 575‑ PubMed: https://pubmed.ncbi.nlm.nih.gov/19528392

Figures:

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