Clinical characteristics and treatment of hepatic portal venous gas: case series and literature review.

BACKGROUND

Hepatic portal venous gas (HPVG) is often regarded as a critical warning sign and has poor patient prognosis if appropriate treatment measures are not promptly administered. There is significant heterogeneity in clinical manifestations, diagnostic approaches, and outcomes among patients with HPVG; hence, this study aimed to analyze the clinical characteristics of patients with HPVG and explore more effective treatment methods to provide valuable references for future clinical treatment strategies.

METHODS

A total of 21 patients diagnosed with HPVG using computed tomography at the First People's Hospital of Hangzhou between January 2014 and October 2024 were retrospectively analyzed. A comprehensive analyses of the sex, age, laboratory test results, reasons for admission, comorbidities, treatment methods, and outcomes of patients were done.

RESULTS

The mean age of the 21 patients (13 men and 8 women) was 61.7 years. Patients presented with decreased red blood cell and hemoglobin counts, and increased white blood cell, neutrophil, C-reactive protein, and D-dimer levels. The main etiologies of HPVG were peritonitis (52.4%), post-abdominal surgery (47.6%), intestinal necrosis (33.3%), and gastrointestinal bleeding (28.6%), while the common comorbidities were peritonitis (52.4%), hypertension (52.4%), and coronary heart disease (23.8%). The overall mortality rate of patients with HPVG was 28.6%, and most of the deceased patients had bowel necrosis. Platelet count [odds ratio (OR): 0.979; 95% confidence interval (CI): 0.962-0.997;  = 0.024] and neutrophil levels, (OR: 1.161; 95% CI: 1.019-1.323;  = 0.025), and the presence of hypertension (OR: 15.750; 95% CI: 1.424-174.246;  = 0.025) and peritonitis (OR: 15.750; 95% CI: 1.424-174.246;  = 0.025) were significantly associated with the likelihood of requiring surgical intervention. Most patients had a good prognosis after surgical treatment.

CONCLUSION

This study systematically described the clinical characteristics, etiologies, comorbidities, and prognosis of patients with HPVG and identified predictors indicating the need for surgical intervention.