Clinical characteristics and treatment strategy of portal venous gas: a case series of 15 patients

Purpose: To explore the clinical characteristics and outcomes of patients diagnosed with portal venous gas (PVG). Methods: We collected the patients diagnosed with PVG between July 2014 and October 2021 at Yuxi People’s Hospital, Yunnan Province. Fifteen patients were included (11 males; 27-91 years of age). Then we analyzed the general information and the characteristics of PVG. Furthermore, we evaluated the imaging of PVG by computed tomography. Results: It was shown that six patients had type I PVG (intrahepatic localized PVG), seven had type II (PVG extending to more than two hepatic lobes), and two had type III (extensive gas in the intrahepatic and extrahepatic portal veins and their appendages). Twelve (80%) patients had PVG related to gastrointestinal hypertensive disease, two (13.3%) had PVG related to inflammatory diseases, and one (6.7%) had iatrogenic PVG. Among the 13 patients with liver function data, only one showed clinically significant alterations (alanine aminotransferase: 760 U/L; aspartate aminotransferase: 454 U/L). Four patients underwent surgery; all four patients survived. Among the 11 patients who did not undergo surgery, four died, and seven survived. Conclusion: PVG has typical imaging findings, and its diagnosis mainly depends on imaging examination, especially computed tomography. Gastrointestinal hypertensive disease is the main cause of PVG. And PVG is a secondary disease, so that mortality is not related to PVG but to the etiological disease and the presence or absence of other risk factors.