Hepatic-Portal Venous Gas in Adults

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Abstract
The roentgenographic finding of hepatic-portal venous gas (HPVG) has been reported extensively in the pediatric and radiology literature. The surgical implications and clinical significance have yet to be fully defined. This study reviews the 60 reported cases in the literature and adds 4 new cases. HPVG appears as a branching radiolucency extending to within 2 cm of the liver capsule. HPVG is associated with necrotic bowel (72%), ulcerative colitis (8%), intraabdominal abscess (6%), small bowell obstruction (3%) and gastric ulcer (3%). Mucosal damage, bowel distention and sepsis predispose to HPVG. The current mortality rate of 75% represents an improvement from previous experience. Analysis of survivors indicates that the binding of HPVG requires urgent surgical exploration except when it is observed in patients with stable ulcerative colitis.

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