Fahrner René, Rauchfuss Falk, Scheuerlein Hubert, Settmacher Utz
University Hospital Jena, Division of General, Visceral and Vascular Surgery, Am Klinikum 1, 07740, Jena, Germany.
St. Vincenz Hospital, Division of General and Visceral Surgery, Am Busdorf 2, 33098, Paderborn, Germany.
BMC Surg. 2018 Mar 2;18(1):14. doi: 10.1186/s12893-018-0345-z.
There are numerous causes of hepatic gas formation that range from serious pathologies to incidental findings, including mesenteric infarction, liver abscess, inflammatory bowel disease or minimally invasive hepatic interventions.
We report a case of a 50-year-old man who was admitted to the emergency room after a car accident. The clinical examination and further diagnostics revealed a craniocerebral injury with a fracture of the skull, concomitant soft tissue lesions and subarachnoidal bleeding. Furthermore, a blunt thoracic trauma with hemopneumothorax due to rib fractures was treated with a chest tube. No obvious abdominal pathology was seen. While in the operating theatre for the surgical revision of the cranial soft tissue lesions, a femoral venous catheter was inserted without any complications. A routine ultrasound of the abdomen six hours after the trauma revealed unclear hepatic gas formation. A contrast-enhanced computer tomography (CT) scan of the abdomen was performed, and the gas formation was found to be localized within the left hepatic vein. Afterwards, there was no specific treatment of the hepatic venous gas formation, as no alterations of liver function or liver enzymes were seen. The further course of the patient was uneventful regarding the gas formation in the liver, and another ultrasound two days later revealed no further gas in the liver.
The placement of a femoral venous catheter is a risk factor for gas formation in liver veins. No further treatment is needed in cases with stable liver function. To rule out serious pathologies, diagnostic findings (e.g., ultrasound, CT), clinical history and underlying diseases need to be analyzed carefully after the detection of intrahepatic gas formation. With contrast-enhanced CT, the localization of the gas and its potential causes might be detectable.
肝内气体形成的原因众多，从严重病变到偶然发现不等，包括肠系膜梗死、肝脓肿、炎症性肠病或微创肝脏介入手术。
我们报告一例50岁男性，在车祸后被送入急诊室。临床检查及进一步诊断显示为颅脑损伤伴颅骨骨折、伴有软组织损伤和蛛网膜下腔出血。此外，因肋骨骨折导致的血气胸钝性胸部创伤通过胸腔闭式引流管进行了治疗。未发现明显的腹部病变。在手术室对颅骨软组织损伤进行手术修复时，插入了股静脉导管，未出现任何并发症。创伤后6小时常规腹部超声显示肝内气体形成情况不明。进行了腹部增强计算机断层扫描（CT），发现气体形成局限于左肝静脉内。此后，由于未观察到肝功能或肝酶的改变，未对肝静脉气体形成进行特殊治疗。就肝脏内的气体形成而言，患者的后续病程平稳，两天后的另一次超声检查显示肝脏内没有进一步的气体。
股静脉导管的放置是肝静脉气体形成的一个危险因素。肝功能稳定的病例无需进一步治疗。在检测到肝内气体形成后，需要仔细分析诊断结果（如超声、CT）、临床病史和基础疾病，以排除严重病变。通过增强CT，可能检测到气体的定位及其潜在原因。
