HEPATIC PORTAL-VEIN GAS FOLLOWING BLUNT COLON INJURY - REPORT OF A CASE

Blunt colon injuries sometimes result in signs of peritoneal irritatio n requiring exploratory laparotomy More frequently there are no specif ic symptoms, and this leads to a delay in diagnosis and management. So me imaging studies point to blunt colon injury, but gas in both the he patic portal and mesenteric veins has rarely been reported. Hepatic po rtal venous gas (HPVG) is a rare roentgenographic picture, and its pre sence usually represents a serious intra-abdominal catastrophe. Comput ed tomography and plain abdominal X ray in a 52-year-old man with blun t abdominal injury show ed significant gas in the portal venous system and pneumatosis intestinales of the ascending colon. Exploratory lapa rotomy revealed segmental necrosis of the transverse colon in front of the vertebrae. The presence of HPVG may have been due to mucosal disr uption, vascular compromise or prolonged increased intra-abdominal pre ssure. its presence in patients with blunt abdominal trauma suggests t he possibility of bowel injury. Surgical exploration should be conside red when HPVG is noted on roentgenographic studies.