Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
Singapore Med J. 2009 Oct;50(10):1023-8; quiz 1029.
A 66-year-old man presented with epigastric pain. Computed tomography (CT) of the abdomen showed portal venous gas with partial thrombosis of the portal veins, consistent with portal pyaemia. CT also showed nonspecific peripancreatic fat stranding. The patient was treated conservatively but did not improve, necessitating a laparotomy that revealed ischaemic colitis and bowel necrosis. He underwent a right hemicolectomy and showed clinical improvement. Portal pyaemia is a combination of infection and thrombosis within the portal veins. The presence of gas in the portal vein is a known feature in portal pyaemia. We showed radiological examples of hepatic and portal venous gas in several patients who presented to our institution, with a brief discussion of their radiological findings, causes, management and outcome. The mortality rate of patients with portal venous gas depends on the underlying cause. The high mortality rate of patients with portal venous gas due to bowel necrosis or ischaemia may necessitate emergent surgical intervention.
一位 66 岁男性出现上腹痛。腹部 CT 显示门静脉气体伴有门静脉部分血栓形成，符合门静脉性败血症。CT 还显示非特异性胰周脂肪条索状影。患者接受保守治疗，但未见改善，需要剖腹探查，结果显示缺血性结肠炎和肠坏死。他接受了右半结肠切除术，临床症状得到改善。门静脉性败血症是门静脉内感染和血栓形成的组合。门静脉内气体的存在是门静脉性败血症的一个已知特征。我们展示了几例在我院就诊的患者的肝内和门静脉气体的影像学表现，并简要讨论了其影像学发现、病因、处理和结果。门静脉气体患者的死亡率取决于潜在病因。由于肠坏死或缺血导致的门静脉气体患者的高死亡率可能需要紧急手术干预。
