Ho M C, Hu R H
Department of Surgery, National Taiwan University Hospital, Taipei.
J Formos Med Assoc. 1995 Sep;94(9):578-80.
Blunt colon injuries sometimes result in signs of peritoneal irritation requiring exploratory laparotomy. More frequently there are no specific symptoms, and this leads to a delay in diagnosis and management. Some imaging studies point to blunt colon injury, but gas in both the hepatic portal and mesenteric veins has rarely been reported. Hepatic portal venous gas (HPVG) is a rare roentgenographic picture, and its presence usually represents a serious intra-abdominal catastrophe. Computed tomography and plain abdominal X ray in a 52-year-old man with blunt abdominal injury showed significant gas in the portal venous system and pneumatosis intestinales of the ascending colon. Exploratory laparotomy revealed segmental necrosis of the transverse colon in front of the vertebrae. The presence of HPVG may have been due to mucosal disruption, vascular compromise or prolonged increased intra-abdominal pressure. Its presence in patients with blunt abdominal trauma suggests the possibility of bowel injury. Surgical exploration should be considered when HPVG is noted on roentgenographic studies.
钝性结肠损伤有时会导致腹膜刺激征，需要进行剖腹探查术。更常见的情况是没有特定症状，这导致诊断和治疗延迟。一些影像学检查提示钝性结肠损伤，但肝门静脉和肠系膜静脉内出现气体的情况很少被报道。肝门静脉气体（HPVG）是一种罕见的影像学表现，其出现通常代表严重的腹腔内灾难。一名52岁腹部钝性损伤男性的计算机断层扫描和腹部平片显示门静脉系统有大量气体以及升结肠积气。剖腹探查发现椎体前方横结肠节段性坏死。HPVG的出现可能是由于黏膜破裂、血管受损或腹腔内压力长期升高。腹部钝性创伤患者出现HPVG提示可能存在肠损伤。当影像学检查发现HPVG时，应考虑进行手术探查。
