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Portal venous gas in intestinal malrotation with mild midgut volvulus.
Surg Case Rep 2019; 5(1):141SC

Abstract

BACKGROUND

Portal venous gas has been considered as a radiological sign requiring urgent operative intervention; however, the reports concerning portal venous gas associated with favorable outcome are recently increasing.

CASE PRESENTATION

We describe a 9-month-old boy with acute onset high fever and vomiting. The ultrasonography demonstrated micro-gas bubbles continuously floating in the intrahepatic portal vein. Contrast-enhanced CT, performed 1 h later from echography, revealed a whirlpool sign suggesting an intestinal malrotation with midgut volvulus, but with no signs of residual intrahepatic gas. Operative findings showed a mild volvulus with neither congestion nor ischemic change of the twisted bowel. Detorsion and Ladd's procedure were completed laparoscopically.

CONCLUSIONS

Transient portal venous gas bubbles may be generated even in the mild intestinal volvulus with no bowel ischemia. Ultrasonography can be a sensitive detector to visualize such small amounts of gas.

Authors+Show Affiliations

Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan. rhirose@fukuoka-u.ac.jp.Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan.Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan.Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan.Division of Pediatrics, Fukuoka Central Hospital, 2-6-11, Yakuin Chuo-ku, Fukuoka, 810-0022, Japan.Division of Radiological Technologist, Fukuoka Central Hospital, 2-6-11, Yakuin Chuo-ku, Fukuoka, 810-0022, Japan.Division of Radiological Technologist, Fukuoka Central Hospital, 2-6-11, Yakuin Chuo-ku, Fukuoka, 810-0022, Japan.Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, 7-45-1, Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31520296

Citation

Hirose, Ryuichiro, et al. "Portal Venous Gas in Intestinal Malrotation With Mild Midgut Volvulus." Surgical Case Reports, vol. 5, no. 1, 2019, p. 141.
Hirose R, Kai H, Inatomi K, et al. Portal venous gas in intestinal malrotation with mild midgut volvulus. Surg Case Rep. 2019;5(1):141.
Hirose, R., Kai, H., Inatomi, K., Iwanaka, T., Morishima, N., Ikeda, M., ... Iwasaki, A. (2019). Portal venous gas in intestinal malrotation with mild midgut volvulus. Surgical Case Reports, 5(1), p. 141. doi:10.1186/s40792-019-0700-z.
Hirose R, et al. Portal Venous Gas in Intestinal Malrotation With Mild Midgut Volvulus. Surg Case Rep. 2019 Sep 13;5(1):141. PubMed PMID: 31520296.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Portal venous gas in intestinal malrotation with mild midgut volvulus. AU - Hirose,Ryuichiro, AU - Kai,Hiroki, AU - Inatomi,Kaori, AU - Iwanaka,Tsuyoshi, AU - Morishima,Naomi, AU - Ikeda,Momotoshi, AU - Masaki,Reiko, AU - Iwasaki,Akinori, Y1 - 2019/09/13/ PY - 2019/07/12/received PY - 2019/08/30/accepted PY - 2019/9/15/entrez PY - 2019/9/15/pubmed PY - 2019/9/15/medline KW - Laparoscopic operation KW - Malrotation KW - Midgut volvulus KW - Portal venous gas SP - 141 EP - 141 JF - Surgical case reports JO - Surg Case Rep VL - 5 IS - 1 N2 - BACKGROUND: Portal venous gas has been considered as a radiological sign requiring urgent operative intervention; however, the reports concerning portal venous gas associated with favorable outcome are recently increasing. CASE PRESENTATION: We describe a 9-month-old boy with acute onset high fever and vomiting. The ultrasonography demonstrated micro-gas bubbles continuously floating in the intrahepatic portal vein. Contrast-enhanced CT, performed 1 h later from echography, revealed a whirlpool sign suggesting an intestinal malrotation with midgut volvulus, but with no signs of residual intrahepatic gas. Operative findings showed a mild volvulus with neither congestion nor ischemic change of the twisted bowel. Detorsion and Ladd's procedure were completed laparoscopically. CONCLUSIONS: Transient portal venous gas bubbles may be generated even in the mild intestinal volvulus with no bowel ischemia. Ultrasonography can be a sensitive detector to visualize such small amounts of gas. SN - 2198-7793 UR - https://www.unboundmedicine.com/medline/citation/31520296/Portal_venous_gas_in_intestinal_malrotation_with_mild_midgut_volvulus L2 - https://dx.doi.org/10.1186/s40792-019-0700-z DB - PRIME DP - Unbound Medicine ER -