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Hepatic portal venous gas with pneumatosis intestinalis secondary to mesenteric ischemia in elderly patients: Two case reports

INTRODUCTION: Hepatic portal venous gas (HPVG) is a rare imaging finding. When HPVG is accompanied with pneumatosis intestinalis (PI), the underlying cause is usually mesenteric ischemia with consequent intestinal necrosis. This combination of clinical conditions is associated with a poor prognosis....

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Autores principales: Wang, Minjia, Song, Jia, Gong, Shijin, Yu, Yihua, Hu, Weihang, Wang, Yueben
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220781/
https://www.ncbi.nlm.nih.gov/pubmed/32332623
http://dx.doi.org/10.1097/MD.0000000000019810
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author Wang, Minjia
Song, Jia
Gong, Shijin
Yu, Yihua
Hu, Weihang
Wang, Yueben
author_facet Wang, Minjia
Song, Jia
Gong, Shijin
Yu, Yihua
Hu, Weihang
Wang, Yueben
author_sort Wang, Minjia
collection PubMed
description INTRODUCTION: Hepatic portal venous gas (HPVG) is a rare imaging finding. When HPVG is accompanied with pneumatosis intestinalis (PI), the underlying cause is usually mesenteric ischemia with consequent intestinal necrosis. This combination of clinical conditions is associated with a poor prognosis. In this study, we present the cases of 2 elderly patients with HPVG and PI secondary to mesenteric ischemia. PATIENT CONCERNS: In case 1, a 89-year-old male patient was admitted to intensive care unit with respiratory failure, On the fifth day of admission, he developed a high fever (39.5°C) and abdominal distension. In case 2, a 92-year-old male patient admitted to our intensive care unit and received mechanical ventilation due to acute respiratory failure. During the treatment, the patient developed gastrointestinal bleeding. On physical examination, abdominal bulging and tense abdominal walls were detected. Both patients underwent abdominal contrast-enhanced computed tomography, showed abundant HPVG with PI. DIAGNOSES: The patients were diagnosed as acute mesenteric ischemia, bowel necrosis, septic shock, multiple organ dysfunction syndrome based on computed tomography scan, abdominal signs, and laboratory tests. INTERVENTIONS: Fluid resuscitation, high-dose vasopressors, and intravenous antibiotic therapy were given. OUTCOMES: Despite prompt treatment, the condition of both patients rapidly deteriorated, and the patients died shortly thereafter. CONCLUSION: Mesenteric ischemia is a clinical emergency. In patients with risk factors and abdominal signs, the clinical suspicion for this condition should be high. Although rare, both HPVG and PI are important radiological clues that usually indicate the presence of mesenteric ischemia with consequent intestinal necrosis.
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spelling pubmed-72207812020-06-15 Hepatic portal venous gas with pneumatosis intestinalis secondary to mesenteric ischemia in elderly patients: Two case reports Wang, Minjia Song, Jia Gong, Shijin Yu, Yihua Hu, Weihang Wang, Yueben Medicine (Baltimore) 3900 INTRODUCTION: Hepatic portal venous gas (HPVG) is a rare imaging finding. When HPVG is accompanied with pneumatosis intestinalis (PI), the underlying cause is usually mesenteric ischemia with consequent intestinal necrosis. This combination of clinical conditions is associated with a poor prognosis. In this study, we present the cases of 2 elderly patients with HPVG and PI secondary to mesenteric ischemia. PATIENT CONCERNS: In case 1, a 89-year-old male patient was admitted to intensive care unit with respiratory failure, On the fifth day of admission, he developed a high fever (39.5°C) and abdominal distension. In case 2, a 92-year-old male patient admitted to our intensive care unit and received mechanical ventilation due to acute respiratory failure. During the treatment, the patient developed gastrointestinal bleeding. On physical examination, abdominal bulging and tense abdominal walls were detected. Both patients underwent abdominal contrast-enhanced computed tomography, showed abundant HPVG with PI. DIAGNOSES: The patients were diagnosed as acute mesenteric ischemia, bowel necrosis, septic shock, multiple organ dysfunction syndrome based on computed tomography scan, abdominal signs, and laboratory tests. INTERVENTIONS: Fluid resuscitation, high-dose vasopressors, and intravenous antibiotic therapy were given. OUTCOMES: Despite prompt treatment, the condition of both patients rapidly deteriorated, and the patients died shortly thereafter. CONCLUSION: Mesenteric ischemia is a clinical emergency. In patients with risk factors and abdominal signs, the clinical suspicion for this condition should be high. Although rare, both HPVG and PI are important radiological clues that usually indicate the presence of mesenteric ischemia with consequent intestinal necrosis. Wolters Kluwer Health 2020-04-24 /pmc/articles/PMC7220781/ /pubmed/32332623 http://dx.doi.org/10.1097/MD.0000000000019810 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 3900
Wang, Minjia
Song, Jia
Gong, Shijin
Yu, Yihua
Hu, Weihang
Wang, Yueben
Hepatic portal venous gas with pneumatosis intestinalis secondary to mesenteric ischemia in elderly patients: Two case reports
title Hepatic portal venous gas with pneumatosis intestinalis secondary to mesenteric ischemia in elderly patients: Two case reports
title_full Hepatic portal venous gas with pneumatosis intestinalis secondary to mesenteric ischemia in elderly patients: Two case reports
title_fullStr Hepatic portal venous gas with pneumatosis intestinalis secondary to mesenteric ischemia in elderly patients: Two case reports
title_full_unstemmed Hepatic portal venous gas with pneumatosis intestinalis secondary to mesenteric ischemia in elderly patients: Two case reports
title_short Hepatic portal venous gas with pneumatosis intestinalis secondary to mesenteric ischemia in elderly patients: Two case reports
title_sort hepatic portal venous gas with pneumatosis intestinalis secondary to mesenteric ischemia in elderly patients: two case reports
topic 3900
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220781/
https://www.ncbi.nlm.nih.gov/pubmed/32332623
http://dx.doi.org/10.1097/MD.0000000000019810
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