Hepatic portal venous gas volume in mesenteric ischemia: the paradox of a potentially fatal finding

Hepatic portal venous gas (HPVG) is the presence of gas in the branches of the portal vein. It can occur due to conditions such as mesenteric ischemia, intra-abdominal abscess, or ileus. HPVG is usually seen as an ominous finding and is associated with high mortality. It is often believed that the volume of HPVG may be related to prognosis and may reflect the amount of ischemic bowel. However, in our two patients with mesenteric ischemia and similar bowel involvement, we did not observe such a relationship. The 76-year-old patient with a smaller volume of HPVG had a poor outcome, while the 72-year-old patient with a larger volume had a better result. These findings indicate that, in mesenteric ischemia–related HPVG, the extent of portal venous gas may not reliably reflect prognosis.