Careful Approach to the ABCs of the Management of Portal Venous Gas

Nelson et al¹ mentioned 182 cases of hepatic portal venous gas (HPVG) documented in the literature by 2001. Between 1975 and 2008, 275 were documented in the literature.² Most were reported after the development of computed tomography (CT) owing to the decreased sensitivity of plain radiography (12.5%).³ Most of the studies support the idea that bowel ischemia as the main cause of this sign (61%) usually manifests radiologically as pneumatosis intestinalis. Iatrogenic HPVG accounts for 3% and idiopathic origin constitutes less than 2%.²