Department of Gastroenterology, Jusendo General Hospital, Fukushima, Japan.
Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
Clin J Gastroenterol. 2023 Aug;16(4):593-598. doi: 10.1007/s12328-023-01797-8. Epub 2023 Apr 11.
Hepatic portal vein gas (HPVG) is caused by the influx of gastrointestinal gas into the intrahepatic portal vein as a result of gastrointestinal wall fragility due to ischemia or necrosis. Gastrointestinal tract necrosis is fatal in severe cases. We observed a case of food intake-induced acute gastric dilatation (AGD) in a healthy young male who developed HPVG and underwent conservative treatment. A 25-year-old male presented to our hospital with epigastric pain and nausea the day after excessive food intake. Computed tomography (CT) revealed gas along the intrahepatic portal vein and marked gastric dilatation with large food residue. AGD-induced HPVG was considered. Esophagogastroduodenoscopy (EGD) was not performed at this stage because of the risk of HPVG and AGD exacerbation, and the patient was followed up with intragastric decompression via a nasogastric tube. Food residue and approximately 2 L of liquid without blood were vomited 1 h after the nasogastric tube placement. His symptoms improved after the vomiting episode. An EGD was performed 2 days after undergoing CT. Endoscopic findings revealed extensive erosions and the presence of a whitish coat extending from the fornix to the lower body of the stomach, indicating AGD. HPVG disappeared on the CT scan taken during EGD. Thereafter, symptom relapse and HPVG recurrence were not observed.
肝门静脉积气（HPVG）是由于胃肠道壁因缺血或坏死而脆弱，导致胃肠道气体流入肝内门静脉所致。在严重的情况下，胃肠道坏死是致命的。我们观察到一例健康年轻男性因摄入食物引起的急性胃扩张（AGD）导致 HPVG 并接受保守治疗的病例。一名 25 岁男性在暴饮暴食后第二天出现上腹痛和恶心。计算机断层扫描（CT）显示肝内门静脉有气体，胃明显扩张，有大量食物残渣。考虑 AGD 引起的 HPVG。由于 HPVG 和 AGD 恶化的风险，此时未进行食管胃十二指肠镜检查（EGD），并通过鼻胃管进行胃内减压以进行随访。放置鼻胃管 1 小时后，吐出了食物残渣和大约 2L 的液体，没有血液。呕吐后，他的症状有所改善。在 CT 后 2 天进行了 EGD。内镜检查结果显示广泛的糜烂，从穹窿到胃体下部有一层白色涂层，提示 AGD。在 EGD 期间进行的 CT 扫描显示 HPVG 消失。此后，未观察到症状复发和 HPVG 复发。
