Mehta Shruti, Desai Gunjan S, Shah Saumil, Mehta Hitesh, Phadke Aniruddha
Department of Internal Medicine, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
Department of Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
Surg J (N Y). 2020 Mar 3;6(1):e37-e41. doi: 10.1055/s-0040-1702919. eCollection 2020 Jan.
Hepatic portal venous gas (HPVG), a rare radiological finding, is historically considered an ominous sign with 100% mortality rates. The dictum that HPVG warrants surgical intervention is challenged in the recent literature. This is because of the identification of various causes of HVPG other than bowel gangrene. Most of these newly identified causes can be managed conservatively. However, bowel gangrene, if missed, is fatal. Hence, sound clinical judgment and accurate diagnosis based on specific clinical parameters and imaging findings are important. We present a case of a young male with tumor lysis syndrome and neutropenic sepsis. He underwent treatment for a relapse of T-cell acute lymphocytic leukemia and presented with abdominal pain and distension. Computed tomography (CT) scan showed HPVG, and the differential diagnosis was neutropenic colitis or pseudomembranous colitis, with steroid use as the probable cause. The patient was managed conservatively. The case emphasizes that the evaluation for a specific cause of HPVG is important to reduce unnecessary surgery. A succinct literature review provides the reasons for the changing mortality rates.
肝门静脉积气（HPVG）是一种罕见的影像学表现，历来被视为不祥之兆，死亡率达100%。近期文献对HPVG需手术干预这一论断提出了挑战。这是因为除了肠坏疽外，还发现了HPVG的各种病因。这些新发现的病因大多可采用保守治疗。然而，肠坏疽若被漏诊则会致命。因此，基于特定临床参数和影像学表现进行合理的临床判断和准确诊断很重要。我们报告一例患有肿瘤溶解综合征和中性粒细胞减少性脓毒症的年轻男性病例。他因T细胞急性淋巴细胞白血病复发接受治疗，出现腹痛和腹胀。计算机断层扫描（CT）显示有HPVG，鉴别诊断为中性粒细胞减少性结肠炎或伪膜性结肠炎，可能病因是使用了类固醇。该患者接受了保守治疗。该病例强调，评估HPVG的特定病因对于减少不必要的手术很重要。简要的文献综述给出了死亡率变化的原因。
