Portal Vein Gas Due to Administration of Fluids via the Umbilical Vein

Gas in the portal veins of the liver has been heralded as an ominous sign (3) since Wolfe and Evans' (7) first report in 1955. They and other workers (5, 6) described the characteristic appearance which differentiates this condition from gas in the biliary system. The usual causes include intestinal necrosis (1, 4), septicemia with gas-forming organisms (6), and necrotizing enterocolitis (2). Because of the increased use of the umbilical vein in administering intravenous fluid, it is felt the introduction of air into the portal system is possible. Such a case is reported to illustrate this finding. Case Report During the process of radiographic examination for tracheoesophageal fistula in a 2-day-old term infant, gas was observed in the portal venous system of the liver (Figs. 1 and 2). Because of this finding the infant was re-examined but found essentially unchanged, only the abdominal gaseous distention being demonstrated. Noted at this same time were wetness and leaking around the umbilical catheter. Earlier laboratory studies and blood culture were negative. Approximately eighteen hours after the roentgen studies, a primary repair of the tracheoesophageal fistula was completed. Postoperative radiographs revealed no gas in the portal venous system of the liver. The infant's course steadily improved, with feedings started the third postoperative day. Death occurred suddenly on the fourth postoperative day due to aspiration. Autopsy disclosed aspiration of gastric material, terminal, with hemorrhage and necrotizing changes in the lungs, but no sequelae from the repair of the tracheoesophageal fistula. The stomach, small intestine, and colon were normal. Tissue Gram stains of the lung, liver, and areas of the tracheoesophageal fistula revealed no Gram-negative rods. Other abnormalities were a large, high ventricular septal defect, congenital absence of the gallbladder with normal extrahepatic ductal system, and incomplete fusion of multiple midthoracic vertebrae. Summary Portal vein gas demonstrated in an infant receiving intravenous fluids through the umbilical vein should suggest this route as a possible source of the air. The clinical course should readily differentiate it from the usually fatal causes of portal venous gas.