Hepatic Portal Venous Gas in Adult: An Ominous Sign

成人肝臟門靜脈氣體：一個惡兆的徵候

蔡建中(Chien-Chung Tsai) ； 曾立榮(Li-Jung Tseng) ； 韓淑珍(Shu-Jen Han) ； 牟聯瑞(Lien Ray Mo)

《中華放射線醫學雜誌》 22卷3期 (1997/06) Pp. 133-135

摘要

我們報告一個成人病例具有肝臟門靜脈氣體，其臨床上的表現是廣泛腹痛及敗血症。腹部超音波顯示在左右兩葉肝臟實質部分有高回音，而在電腦斷層影像則發現在門靜脈系統及左側大腸壁有氣體存在，下腸系膜動脈攝影發現乙狀結腸壁動脈有阻塞。左邊大腸血管性缺血性阻塞造成肝臟門脈內有氣體。由影像結果得到確定的診斷，使用非口服廣效性抗生素乃及輸液，進行積極的救治卻枉然，因而入院36小時後病人即宣告不治。總結而論，醫師必須熟悉此種疾病的各種不同的影像特徵，治療應該是直接了當，以矯正其潛在的疾病。迅速的診斷和適當的治療將影響它的預後。

關鍵字

大腸，電腦斷層 ； 大腸，缺血 ； 門靜脈，氣體

並列摘要

We report a case of hepatic portal venous gas in an adult patient with diffuse abdominal pain and sepsis. Abdominal sonography revealed hyperechoic densities distributed diffusely in both lobes of the liver, while the presence of air in the portal venous system and intramural gas in the left colon were demonstrated on the CT scan. Inferior mesenteric angiogram showed occlusion of the sigmoid arteries. Vascular occlusion of the left colon resulting in hepatic portal venous gas was diagnosed by imaging studies. Intensive resuscitation using parenteral broad spectrum antibiotic, fluids, and inotropic agents were in vain, and the patient unfortunately died 36 hours after admission. In conclusion, the physician must be familiar with the different imaging features of this disease entity, and treatment should focus on correcting the underlying disease. Prompt diagnosis and appropriate therapy will affect its prognosis.

並列關鍵字

Colon, CT ； Colon, ischemia ； Portal vein, gas