Hepatic portal venous gas and pneumatosis intestinalis in a uremic patient with continuous ambulatory peritoneal dialysis

Hepatic portal venous gas (HPVG) is the existence of air in the hepatic portal venous system. It was considered very rare in the past literatures before the introduction of computed tomographic (CT) scan. With special image feature in the abdominal CT scan, HPVG has been well known to be associated with high mortality even while urgent surgical intervention is performed for acute mesenteric infarction. In this paper, we present a 55 year-old woman who was admitted due to dialytic fluid related peritonitis with the manifestations of severe abdominal distension, severe diarrhea, fever, and septic shock. HPVG formation was detected in the CT scan of abdomen, as well as pneumatosis intestinalis (PI) and severe aorta astherosclerosis, implying small bowel necrosis, which was possibly originated from acute mesenteric infarction. Operation was not performed due to severely deteriorated condition. The patient rapidly died despite of antibiotic combination therapy and intensive hemodynamic support. Early recognition of the HPVG and PI combination signs is crucial for prompt diagnosis and management for acute mesenteric infarction.