Transient extensive hepatic portal venous gas following hypotension in a dialysis patient.

A 68-year-old woman developed abdominal pain during a haemodialysis session and was transferred to our hospital. Although initial CT scan at former hospital detected extensive hepatic portal venous gas (HPVG), repeated CT scan on admission performed 2 h after the initial scan demonstrated a marked decrease in HPVG. Although HPVG is associated in some cases with bowel necrosis and high mortality, HPVG completely resolved within 18 h with only conservative treatment in presented case. Because recent increased use of CT scan allows early and highly sensitive detection of HPVG, not only in bowel necrosis, but also in non-life-threatening cases, we usually face a clinical dilemma whether to perform exploratory laparotomy. No previous studies have evaluated the duration of HPVG in detail, although this case suggests the value of CT scan follow-up in relatively stable patient even when the course of HPVG is short.