Wednesday, March 4, 2009
Portal Venous Gas
What you see above are ominous CT findings from a recent patient who presented with sudden, severe abdominal pain. The first slice shows portal venous gas and the second one is illustrative of pneumotosis intestinalis. Portal venous gas is a rare finding most commonly associated with mesenteric ischemia and bowel necrosis. Historically, it has portended a grim prognosis (mortality rates 75-90%). The treatment is cold hard steel, ASAP.
This particular patient had infarcted his cecum for whatever reason. Fortunately the ischemic insult was isolated to the cecum and the bowel had not yet perforated. I did a right hemicolectomy. He did surprisingly well. The odds weren't good, but you figure somebody eventually has to survive this sort of insult right? I've had a few who didn't....