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Portal Venous Gas

Watch video here or read on below...

The IOW this week comes from Dr. Shikha Kapil and MS4s Eli Shinnar and Julia Shinnick. Their patient was an elderly male who presented with abdominal pain. They performed an ultrasound exam to evaluate for small bowel obstruction and obtained this image. 

Image 1:

sbo

On ultrasound SBO is identified by dilated fluid filled loops of bowel measuring greater than 2.5cm across as seen above.  You can see dysfunctional peristalsis as bowel contents swirl back and forth. They continued to scan the abdomen and noticed something unusual in the liver. 

Image 2:

 portal air

There are several abnormalities on this image note the hyperechoic patches located throught out the liver. This is air. In the video small bubbles are also seen circulating in the portal vein. Outside of the liver we  again see  fluid filled bowel loops  with some small surrounding triangles  of anechoic free fluid.  Portal venous gas can occur in a variety of conditions including mesenteric ischemia, ileus and obstruction, perforated peptic ulcer, IBD, necrotic colon cancer, and intrabdominal sepsis (from appendicitis, diverticulitis, cholecystititis etc), It has been associated with high mortality rates largely due to its association with mesenteric ischemia.  This patient’ s lactate returned at 7 and he was taken to the OR for exploratory laparotomy.

Thanks for all of your great images this week!

Happy Scanning! 

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Sierra Beck MD 

Assistant Professor

Department of Emergency Medicine

Emory University SOM