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Original Article |

Hepatic Portal Gas in Adults:  Review of the Literature and Presentation of a Consecutive Series of 11 Cases FREE

Nicolas Peloponissios, MD; Nermin Halkic, MD; Mauro Pugnale, MD; Philippe Jornod, MD; Petter Nordback, MD; Alain Meyer, MD; Michel Gillet, MD
[+] Author Affiliations

From the Departments of Surgery (Drs Peloponissios, Halkic, Nordback, and Gillet), Radiology (Dr Pugnale), and Gastroenterology (Dr Jornod), Centre Hospitalier et Universitaire Vaudois, Lausanne, Switzerland; and the Department of Surgery, District Hospital of Morges, Morges, Switzerland (Dr Meyer).


Arch Surg. 2003;138(12):1367-1370. doi:10.1001/archsurg.138.12.1367.
Text Size: A A A
Published online

Background  Hepatic portal venous gas (HPVG) in adults is a rare entity. The underlying pathologic condition is usually an intestinal ischemia, but it has been reported in association with a variety of conditions.

Hypothesis  Miscomprehension of the underlying pathologic conditions has led to some confusion in the literature concerning its etiology, diagnostic methods, and clinical consequences.

Setting  Centre Hospitalier et Universitaire Vaudois, Lausanne, Switzerland, and District Hospital of Morges, Morges, Switzerland.

Method  Between February 1, 1995, and May 30, 2000, eleven cases of HPVG were treated. These cases were retrospectively reviewed, together with a review of the literature to define the clinical significance of HPVG, the role of the computed tomographic scan, and the necessity of performing systematic emergency exploratory surgery.

Results  Two groups have to be distinguished—those who have HPVG with associated pneumatosis intestinalis and those who have HPVG without associated pneumatosis intestinalis. When associated with pneumatosis intestinalis, the cause is usually an intestinal ischemia and in a symptomatic patient it justifies systematic exploratory surgery. An abdominal computed tomographic scan including lung window settings to better identify air in the bowel wall will distinguish between these 2 groups. Pneumatosis intestinalis and HPVG due to bowel ischemia do not allow prediction of the severity of bowel wall damage.

Conclusions  The cause of HPVG without pneumatosis intestinalis is variable. Good knowledge of the possible causes combined with the clinical picture and the abdominal computed tomographic scan is required to correctly identify the underlying cause of HPVG and to avoid unnecessary surgery.

Figures in this Article

HEPATIC PORTAL venous gas (HPVG) was first reported in neonates in 1955 by Wolfe and Nevins as cited by Liebman et al.1(p281) In adults, it has since been described in association with a variety of pathologic conditions (Table 1) that include intestinal ischemia and necrosis (75% of the cases), ulcerative colitis (8% of the cases), and intra-abdominal abcess (6% of the cases).1,47 Patients with hepatic portal venous gas have a global survival rate of less than 25%1,2 owing to the severity of the underlying pathologic condition that most commonly is intestinal necrosis.1 This is a review of the literature and a retrospective study of 11 reported cases of HPVG that presented between February 1, 1995, and May 30, 2000, at either the Centre Hospitalier et Universitaire Vaudois, Lausanne, Switzerland, or the District Hospital of Morges, Morges, Switzerland. The aim of the study was to clarify the significance and treatment of HPVG, emphasizing the role of performing early exploratory surgery.

Table Graphic Jump LocationTable 1. Uncommon Pathologic Conditions Associated With Hepatic Portal Venous Gas

Our case series included 6 men and 5 women whose mean age was 66 years (age range, 40-84 years). In 6 of the 11 patients the diagnosis of the underlying disease was confirmed by either surgery or autopsy (extensive intestinal ischemia, 3 patients; segmental bowel ischemia, 2 patients; and giant gastric ulcer, 1 patient). One case of pylephlebitis following diverticulitis was confirmed on computed tomographic (CT) scan. In 4 patients intestinal ischemia was suspected but was never confirmed. The diagnosis of HPVG in 10 patients was confirmed by CT scans, although the diagnosis was already suggested after ultrasonography or standard abdominal radiographs in 6 patients. In 9 cases of HPVG, CT scans revealed an associated pneumatosis intestinalis (PI). The 2 other cases of HPVG were not associated with PI and neither of these cases was related to intestinal ischemia. Eight of 11 patients died within 48 hours after presentation. Of the 5 patients who underwent surgery, 2 (40%) survived. These results are summarized in Table 2.

Table Graphic Jump LocationTable 2. Outcome of Patients With Hepatic Portal Venous Gas

Hepatic portal venous gas can be due to gas under pressure in the bowel lumen or to an alteration of the mucosa, allowing the gas to enter the portal system through the mesenteric veins.1 These 2 mechanisms were demonstrated by Shaw et al49 in 1967 using a dog model. Based on these observations, we can hypothesize that any pathologic changes in the mucosa, for example, Crohn disease, may lead to alteration of vessel walls and the surrounding tissue, preventing them from collapsing. Thus, it allows an easier entry for air, as already hypothesized by Katzgraber et al50 in a gastric ulcer. A third mechanism is gas-forming bacteria in an intra-abdominal abscess1,3,4,43 with or without a related pylephlebitis35,51 as observed in our patient 4.

Hepatic portal venous gas can occur alone or in association with PI (Figure 1). When associated with PI, the origin seems to be intestinal ischemia, as observed in our case series. Hepatic portal venous gas is not predictive of its severity when caused by intestinal ischemia1 and has even been observed with reversible ischemia.1,52,53 In this series, 2 cases of HPVG and PI were observed with segmentary bowel ischemia (patients 9 and 10).

Place holder to copy figure label and caption

A, Computed tomographic scan showing a huge volume of hepatic portal venous gas throughout the whole liver, extending to below the hepatic capsule. B, Computed tomographic scan showing an important pneumatosis intestinalis and the presence of air in the mesenteric venous branches.

Graphic Jump Location

Associated portal and inferior or superior vena cava gas has already been described5355 and also has been observed in patient 1 of our case series. In 1 of the 3 reported cases described, air could clearly be observed in the superior and inferior mesenteric, hemorrhoidal, internal iliac, and left colic veins and inferior vena cava. Mallens et al53 hypothesized that the important quantity of gas caused temporary obstruction of the portal sinusoids with portosystemic shunting. In 1 of the cases described by Kriegshauser et al,54 the gas was observed with real-time sonography passing through the liver from the portal veins to the systemic circulation. In the third case the association between HPVG and air in the vena cava was observed in a fulminant sepsis and was attributed to a gas-forming organism causing portal and systemic venous gas.55

Transient cases of HPVG without clinical consequence have been observed in numerous cases (inflammatory bowel disease, acute gastric dilatation, blunt abdominal trauma, jejunostomy catheter insertion, and other isolated cases).45,47,53 Benign HPVG has even been observed, but exceptionally, in association with colonic intramural air.56

Abdominal radiographs can detect large quantities of HPVG or intestinal intramural gas, but its accuracy in demonstrating them is inferior to ultrasonographic or CT scans, both of which allow an earlier detection of small quantities of gas in the portal tract.6,44,57 The finding of HPVG on standard radiographs is suggestive of a poor prognosis and is commonly associated with bowel infarction (patients 7 and 11).6 A radiograph is more revealing in cases of HPVG when taken with the patient lying on his or her left side.1

At echography HPVG appears as numerous small hyperechogenic images with inconstant acoustic shadows.6,58,59 Gas in the portal venous system is carried by the centrifugal flow of blood in the periphery of the liver, appearing to extend to within 2 cm of the hepatic capsule. Inversely, gas in the biliary tract moves with the centripetal flow of bile, thus appearing more centrally in the liver. Ultrasonography gives additional real-time information, allowing the observation of the hepatofugal or hepatopetal gas displacement.59 With concomitant portal hypertension, gas bubbles may be slower to reach the liver periphery, making the diagnosis difficult.7 A history of biliodigestive anastomosis, endoscopic papillotomy, biliary endoprosthesis, or choledocointestinal fistula are certainly of importance in the differential diagnosis.28

With its excellent spatial and contrast resolution, a CT scan provides a conclusive diagnosis in most cases. Furthermore, associated necrotic bowel signs are more specific on CT scan than with ultrasonography. In necrosis, the gas generally produces a bubbly image whereas with innocuous causes, it can be linear or clusterlike, larger and more spherical.60 However, these signs are not specific and do not allow a clear-cut diagnosis. The standard window setting for an abdominal CT scan may overlook even extensive gas, particularly when using restricted windows. Thus, the use of complementary lung window settings is necessary when PI is suspected.61,62 Nevertheless, in all of our cases, PI was clearly observed with standard window settings.

The recognition of HPVG in adults indicates, in most cases, a life-threatening, acute abdominal process. Hepatic portal venous gas as well as PI are radiological clues and not diagnoses. Two groups have to be distinguished–those who have HPVG with associated PI and those who have HPVG without associated PI. When associated with PI, the cause of HPVG is usually an intestinal ischemia and in a symptomatic patient it justifies performing systematic exploratory surgery. An abdominal CT scan, including lung window settings to better identify air in the bowel wall, will distinguish between these 2 groups. Pneumatosis intestinalis and HPVG due to bowel ischemia do not allow prediction of the severity of bowel wall damage. The finding of HPVG on standard radiographs is suggestive of a poor prognosis and is commonly associated with bowel infarction. The cause of HPVG without PI can vary between innocuous and life-threatening causes. Both the patient's history and the clinical findings have to be considered to exclude a benign cause of HPVG and, thus, avoid unnecessary laparotomy. In doubtful cases, a prompt laparoscopic exploratory procedure is mandatory to exclude a surgically treatable disease.

Corresponding author and reprints: Nicolas Peloponissios, MD, Department of Surgery, Centre Hospitalier et Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland (e-mail: nicolas.peloponissios@hospvd.ch).

Accepted for publication May 24, 2003.

Liebman  PRPatten  MTManny  JBenfield  JRHechtman  HB Hepatic portal venous gas in adults: etiology, pathophysiology, and clinical significance. Ann Surg. 1978;187281- 287
PubMed Link to Article
Haner  CInderbitzi  RBadulescu  MTeuscher  J Septische Pylephlebitis mit Nachweis von Gas in der Vena portae: seltene Komplikation der Sigmadivertikulitis. Schweiz Med Wochenschr. 1998;1281339- 1344
PubMed
Cambria  RPMargolies  MN Hepatic portal venous gas in diverticulitis: survival in a steroid-treated patient. Arch Surg. 1982;117834- 835
PubMed Link to Article
Graham  GABernstein  RBGronner  AT Gas in the portal and inferior mesenteric veins caused by diverticulitis of the sigmoid colon: report of a case with survival. Radiology. 1975;114601- 602
PubMed
Castillo  MMurphy  B Septic portal vein thrombophlebitis: computed tomography appearance: case report. Comput Radiol. 1986;10289- 292
PubMed Link to Article
Bodewes  HWPuylaert  JB Ultrasound in detection of portal venous gas in adults. Gastrointest Radiol. 1991;1635- 37
PubMed Link to Article
Lefleur  RSAmbos  MARothberg  MBenjamin  J Angiographic demonstration of gas and thrombus in the portal vein. AJR Am J Roentgenol. 1978;1301171- 1173
PubMed Link to Article
Graham  NG Gas in the portal vein in association with a pelvic abscess. BMJ. 1967;3288
PubMed Link to Article
Zielke  AHasse  CNies  CRothmund  M Hepatic-portal venous gas in acute colonic diverticulitis. Surg Endosc. 1998;12278- 280
PubMed Link to Article
Plemmons  RMDooley  DPLongfield  RN Septic thrombophlebitis of the portal vein (pylephlebitis): diagnosis and management in the modern era. Clin Infect Dis. 1995;211114- 1120
PubMed Link to Article
Haak  HRKooymans-Coutinho  MFvon  TMAdhin  SFalke  TH Portal venous gas in a patient with diverticulitis. Hepatogastroenterology. 1990;37528- 529
PubMed
Bach  MCAnderson  LGMartin  TAJMcAfee  RE Gas in the hepatic portal venous system: a diagnostic clue to an occult intra-abdominal abscess. Arch Intern Med. 1982;1421725- 1726
PubMed Link to Article
Tedesco  FJStanley  RJ Hepatic portal vein gas without bowel infarction or necrosis. Gastroenterology. 1975;69240- 243
PubMed
Burgard  GCuilleron  MCuilleret  J An unusual complication of perforated sigmoid diverticulitis: gas in the portal vein with miliary liver abscesses [in French]. J Chir (Paris). 1993;130237- 239
PubMed
Fataar  SCadogan  ESpruyt  O Ultrasonography of hepatic portal venous gas due to diverticulitis. Br J Radiol. 1986;59183- 185
PubMed Link to Article
Chang  SGLee  SCHong  DHChai  SE Portal and superior mesenteric venous gas with retroperitoneal abscess—CT diagnosis (case report). J Korean Med Sci. 1992;762- 65
PubMed
Speer  CSCarlson  DH Portal venous air with survival in ulcerative colitis: report of a case. Dis Colon Rectum. 1972;15453- 458
PubMed Link to Article
Moss  MLMazzeo  JT Pneumoperitoneum and portal venous air after barium enema. Va Med Q. Fall1991;118233- 235
PubMed
Maamary  Rde Toeuf  JPotvliege  R Hepatic portal venous gas (HPVG) following double-contrast barium enema in granulomatous colitis: a case report [in French]. J Belge Radiol. 1981;64175- 178
PubMed
Sadhu  VKBrennan  REMadan  V Portal vein gas following air-contrast barium enema in granulomatous colitis: report of a case. Gastrointest Radiol. 1979;4163- 164
PubMed Link to Article
Christensen  MALu  CH Gas in the portal vein after air-contrast barium enema in a patient with inflammatory colitis. South Med J. 1982;751291- 1292
PubMed Link to Article
Huycke  AMoeller  DD Hepatic portal venous gas after colonoscopy in granulomatous colitis. Am J Gastroenterol. 1985;80637- 638
PubMed
Birnberg  FAGore  RMShragg  BMargulis  AR Hepatic portal venous gas: a benign finding in a patient with ulcerative colitis. J Clin Gastroenterol. 1983;589- 91
PubMed Link to Article
Katz  BHSchwartz  SSVender  RJ Portal venous gas following a barium enema in a patient with Crohn's colitis: a benign finding. Dis Colon Rectum. 1986;2949- 51
PubMed Link to Article
Haber  I Hepatic portal vein gas following colonoscopy in ulcerative colitis: report of a case. Acta Gastroenterol Belg. 1983;4614- 17
PubMed
Pappas  DRomeu  JTarkin  NDave  PBMesser  J Portal vein gas in a patient with Crohn's colitis. Am J Gastroenterol. 1984;79728- 730
PubMed
Kees  CJHester  CLJ Portal vein gas following barium enema examination. Radiology. 1972;102525- 526
PubMed
Gosink  BB Intrahepatic gas: differential diagnosis. AJR Am J Roentgenol. 1981;137763- 767
PubMed Link to Article
Kirsch  MBozdech  JGardner  DA Hepatic portal venous gas: an unusual presentation of Crohn's disease. Am J Gastroenterol. 1990;851521- 1523
PubMed
Ajzen  SAGibney  RGCooperberg  PLScudamore  CHMiller  RR Enterovenous fistula: unusual complication of Crohn disease. Radiology. 1988;166745- 746
PubMed
Stein  MGCrues  JVHamlin  JA Portal venous air associated with barium enema. AJR Am J Roentgenol. 1983;1401171- 1172
PubMed Link to Article
Lee  CSKuo  YCPeng  SM  et al.  Sonographic detection of hepatic portal venous gas associated with suppurative cholangitis. J Clin Ultrasound. 1993;21331- 334
PubMed Link to Article
Dennis  MAPretorius  DManco-Johnson  MLBangert-Burroughs  K CT detection of portal venous gas associated with suppurative cholangitis and cholecystitis. AJR Am J Roentgenol. 1985;1451017- 1018
PubMed Link to Article
Edwards  AMMichalyshyn  BCostopoulos  LB Survival following gas in the portal venous system: a report of two cases. CMAJ. 1967;971029- 1031
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Benson  MD Adult survival with intrahepatic portal venous gas secondary to acute gastric dilatation, with a review of portal venous gas. Clin Radiol. 1985;36441- 443
PubMed Link to Article
Hughes  DGBarker  CS Adult survival with portal venous gas secondary to acute gastric dilation. Clin Radiol. 1986;37603
PubMed Link to Article
Radin  DRRosen  RSHalls  JM Acute gastric dilatation: a rare cause of portal venous gas. AJR Am J Roentgenol. 1987;148279- 280
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Merine  DFishman  EK Uncomplicated portal venous gas associated with duodenal perforation following ERCP: CT features. J Comput Assist Tomogr. 1989;13138- 139
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Friedman  DFlancbaum  LRitter  ETrooskin  SZ Hepatic portal venous gas identified by computed tomography in a patient with blunt abdominal trauma: a case report. J Trauma. 1991;31290- 292
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Pfaffenbach  BWegener  MBohmeke  T Hepatic portal venous gas after transgastric EUS-guided fine-needle aspiration of an accessory spleen. Gastrointest Endosc. 1996;43515- 518
PubMed Link to Article
Shaw  ACooperman  AFusco  J Gas embolism produced by hydrogen peroxide. N Engl J Med. 1967;277238- 241
PubMed Link to Article
Katzgraber  FGlenewinkel  FFischler  SRittner  C Mechanism of fatal air embolism after gastrointestinal endoscopy. Int J Legal Med. 1998;111154- 156
PubMed Link to Article
Ghani  AKasirajan  KSmith  J Portal pyelophlebitis identified by CT scan in a patient with ischemic bowel. Am Surg. 1995;611039- 1040
PubMed
Berne  TVMeyers  HIDonovan  AJ Gas in the portal vein of adults with necrotizing enteropathy. Am J Surg. 1970;120203- 209
PubMed Link to Article
Mallens  WMSchepers-Bok  RNicolai  JJJacobs  FAHeyerman  HG Portal and systemic venous gas in a patient with cystic fibrosis: CT findings. AJR Am J Roentgenol. 1995;165338- 339
PubMed Link to Article
Kriegshauser  JSReading  CCKing  BFWelch  TJ Combined systemic and portal venous gas: sonographic and CT detection in two cases. AJR Am J Roentgenol. 1990;1541219- 1221
PubMed Link to Article
Jones  B Massive gas embolism in E. coli septicemia. Gastrointest Radiol. 1981;6161- 163
PubMed Link to Article
Fisher  JK Computed tomography of colonic pneumatosis intestinalis with mesenteric and portal venous air. J Comput Assist Tomogr. 1984;8573- 574
PubMed Link to Article
Radin  DRRosen  RSHalls  JM Acute gastric dilatation: a rare cause of portal venous gas. AJR Am J Roentgenol. 1987;148279- 280
PubMed Link to Article
Laing  FCRego  JDJJeffrey  RB Ultrasonographic identification of portal vein gas. J Clin Ultrasound. 1984;12512- 514
PubMed Link to Article
Nachtegaele  PAfschrift  MVandendriessche  MVan  RRVoet  DVerdonk  G Sonographic diagnosis of gas embolism in the portal vein. Gastrointest Radiol. 1982;7375- 377
PubMed Link to Article
Pear  BL Pneumatosis intestinalis: a review. Radiology. 1998;20713- 19
PubMed
Boerner  RMFried  DBWarshauer  DMIsaacs  K Pneumatosis intestinalis: two case reports and a retrospective review of the literature from 1985 to 1995. Dig Dis Sci. 1996;412272- 2285
PubMed Link to Article
Scheidler  JStabler  AKleber  GNeidhardt  D Computed tomography in pneumatosis intestinalis: differential diagnosis and therapeutic consequences. Abdom Imaging. 1995;20523- 528
PubMed Link to Article

Figures

Place holder to copy figure label and caption

A, Computed tomographic scan showing a huge volume of hepatic portal venous gas throughout the whole liver, extending to below the hepatic capsule. B, Computed tomographic scan showing an important pneumatosis intestinalis and the presence of air in the mesenteric venous branches.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 1. Uncommon Pathologic Conditions Associated With Hepatic Portal Venous Gas
Table Graphic Jump LocationTable 2. Outcome of Patients With Hepatic Portal Venous Gas

References

Liebman  PRPatten  MTManny  JBenfield  JRHechtman  HB Hepatic portal venous gas in adults: etiology, pathophysiology, and clinical significance. Ann Surg. 1978;187281- 287
PubMed Link to Article
Haner  CInderbitzi  RBadulescu  MTeuscher  J Septische Pylephlebitis mit Nachweis von Gas in der Vena portae: seltene Komplikation der Sigmadivertikulitis. Schweiz Med Wochenschr. 1998;1281339- 1344
PubMed
Cambria  RPMargolies  MN Hepatic portal venous gas in diverticulitis: survival in a steroid-treated patient. Arch Surg. 1982;117834- 835
PubMed Link to Article
Graham  GABernstein  RBGronner  AT Gas in the portal and inferior mesenteric veins caused by diverticulitis of the sigmoid colon: report of a case with survival. Radiology. 1975;114601- 602
PubMed
Castillo  MMurphy  B Septic portal vein thrombophlebitis: computed tomography appearance: case report. Comput Radiol. 1986;10289- 292
PubMed Link to Article
Bodewes  HWPuylaert  JB Ultrasound in detection of portal venous gas in adults. Gastrointest Radiol. 1991;1635- 37
PubMed Link to Article
Lefleur  RSAmbos  MARothberg  MBenjamin  J Angiographic demonstration of gas and thrombus in the portal vein. AJR Am J Roentgenol. 1978;1301171- 1173
PubMed Link to Article
Graham  NG Gas in the portal vein in association with a pelvic abscess. BMJ. 1967;3288
PubMed Link to Article
Zielke  AHasse  CNies  CRothmund  M Hepatic-portal venous gas in acute colonic diverticulitis. Surg Endosc. 1998;12278- 280
PubMed Link to Article
Plemmons  RMDooley  DPLongfield  RN Septic thrombophlebitis of the portal vein (pylephlebitis): diagnosis and management in the modern era. Clin Infect Dis. 1995;211114- 1120
PubMed Link to Article
Haak  HRKooymans-Coutinho  MFvon  TMAdhin  SFalke  TH Portal venous gas in a patient with diverticulitis. Hepatogastroenterology. 1990;37528- 529
PubMed
Bach  MCAnderson  LGMartin  TAJMcAfee  RE Gas in the hepatic portal venous system: a diagnostic clue to an occult intra-abdominal abscess. Arch Intern Med. 1982;1421725- 1726
PubMed Link to Article
Tedesco  FJStanley  RJ Hepatic portal vein gas without bowel infarction or necrosis. Gastroenterology. 1975;69240- 243
PubMed
Burgard  GCuilleron  MCuilleret  J An unusual complication of perforated sigmoid diverticulitis: gas in the portal vein with miliary liver abscesses [in French]. J Chir (Paris). 1993;130237- 239
PubMed
Fataar  SCadogan  ESpruyt  O Ultrasonography of hepatic portal venous gas due to diverticulitis. Br J Radiol. 1986;59183- 185
PubMed Link to Article
Chang  SGLee  SCHong  DHChai  SE Portal and superior mesenteric venous gas with retroperitoneal abscess—CT diagnosis (case report). J Korean Med Sci. 1992;762- 65
PubMed
Speer  CSCarlson  DH Portal venous air with survival in ulcerative colitis: report of a case. Dis Colon Rectum. 1972;15453- 458
PubMed Link to Article
Moss  MLMazzeo  JT Pneumoperitoneum and portal venous air after barium enema. Va Med Q. Fall1991;118233- 235
PubMed
Maamary  Rde Toeuf  JPotvliege  R Hepatic portal venous gas (HPVG) following double-contrast barium enema in granulomatous colitis: a case report [in French]. J Belge Radiol. 1981;64175- 178
PubMed
Sadhu  VKBrennan  REMadan  V Portal vein gas following air-contrast barium enema in granulomatous colitis: report of a case. Gastrointest Radiol. 1979;4163- 164
PubMed Link to Article
Christensen  MALu  CH Gas in the portal vein after air-contrast barium enema in a patient with inflammatory colitis. South Med J. 1982;751291- 1292
PubMed Link to Article
Huycke  AMoeller  DD Hepatic portal venous gas after colonoscopy in granulomatous colitis. Am J Gastroenterol. 1985;80637- 638
PubMed
Birnberg  FAGore  RMShragg  BMargulis  AR Hepatic portal venous gas: a benign finding in a patient with ulcerative colitis. J Clin Gastroenterol. 1983;589- 91
PubMed Link to Article
Katz  BHSchwartz  SSVender  RJ Portal venous gas following a barium enema in a patient with Crohn's colitis: a benign finding. Dis Colon Rectum. 1986;2949- 51
PubMed Link to Article
Haber  I Hepatic portal vein gas following colonoscopy in ulcerative colitis: report of a case. Acta Gastroenterol Belg. 1983;4614- 17
PubMed
Pappas  DRomeu  JTarkin  NDave  PBMesser  J Portal vein gas in a patient with Crohn's colitis. Am J Gastroenterol. 1984;79728- 730
PubMed
Kees  CJHester  CLJ Portal vein gas following barium enema examination. Radiology. 1972;102525- 526
PubMed
Gosink  BB Intrahepatic gas: differential diagnosis. AJR Am J Roentgenol. 1981;137763- 767
PubMed Link to Article
Kirsch  MBozdech  JGardner  DA Hepatic portal venous gas: an unusual presentation of Crohn's disease. Am J Gastroenterol. 1990;851521- 1523
PubMed
Ajzen  SAGibney  RGCooperberg  PLScudamore  CHMiller  RR Enterovenous fistula: unusual complication of Crohn disease. Radiology. 1988;166745- 746
PubMed
Stein  MGCrues  JVHamlin  JA Portal venous air associated with barium enema. AJR Am J Roentgenol. 1983;1401171- 1172
PubMed Link to Article
Lee  CSKuo  YCPeng  SM  et al.  Sonographic detection of hepatic portal venous gas associated with suppurative cholangitis. J Clin Ultrasound. 1993;21331- 334
PubMed Link to Article
Dennis  MAPretorius  DManco-Johnson  MLBangert-Burroughs  K CT detection of portal venous gas associated with suppurative cholangitis and cholecystitis. AJR Am J Roentgenol. 1985;1451017- 1018
PubMed Link to Article
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