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Exploring the use of single-port surgery in the conservative management of hepatic portal vein gas: A case report.

ABSTRACT:

Rationale

Hepatic portal vein gas (HPVG) is known as a sign of a lethal condition resulting from bowel necrosis. Recently, the detection rate of non-life-threatening cases of HPVG has increased due to the technological development of imaging, i.e., computed tomography (CT). However, it is difficult to determine accurately whether surgical treatment is necessary because of its lethal potential.

Patient concerns

A 74-year-old woman suddenly complained about lower abdominal pain and vomiting after an operation for cervical spondylosis myelopathy. Her vital signs were slightly unstable and she was perspiring and exhibited pallor. Muscular defense was not clear, though her abdomen was tender and slightly distended.

Diagnosis

CT results showed massive HPVG. However, laboratory investigation did not clearly indicate bowel necrosis. Also, a contrast-CT scan was not performed due to her chronic renal dysfunction and asthma.

Intervention

Exploration was performed by single-port surgery (SPS) instead of exploratory laparotomy.

Outcome

This approach showed no ischemic bowel and so conservative therapies were undertaken with confidence. The HPVG disappeared 2 days later, and she recover completely from the illness.

Lessons

HPVG requires immediate and reliable decision for management. However, unnecessary exploratory laparotomy should be avoided. Hence, a novel strategy should be considered in light of innovative surgical procedures. Our experience suggested that SPS was useful as an exploratory tool for the management of HPVG.

SUBMITTER: Taniguchi K

PROVIDER: S-EPMC6392919 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundHepatic portal vein gas (HPVG), which is a rare clinical manifestation, is usually considered a sign of critical illness. If the treatment is not timely, it will lead to intestinal ischemia, intestinal necrosis, and even death. There is still no consensus on whether to adopt surgical or conservative treatment for HPVG. Herein, we report a rare case of conservative treatment of HPVG after transarterial chemoembolization (TACE) treatment in a patient with liver metastasis of postoperative esophageal cancer, who received long-term enteral nutrition (EN).Case descriptionA 69-year-old male patient, who had undergone surgery for esophageal cancer, needed long-term use of jejunal feeding tube implantation for enteral nutritional support due to postoperative complications. About 9 months after the operation, multiple metastases of the liver were detected. To control the progress of the disease, TACE was conducted. EN was restored on the second day after TACE, and the patient was discharged on the fifth day. On the night of discharge, the patient suddenly experienced abdominal pain, nausea, and vomiting. Abdominal computed tomography (CT) showed that the abdominal intestinal lumen was obviously dilated, liquid and gas plane shadowing was visible, and gas was visible in the portal vein and its branches. The physical examination showed that peritoneal irritation was present, and bowel sounds were active. Blood routine examination showed an increase in neutrophil and neutrophil. Symptomatic treatment, including gastrointestinal decompression, anti-infection, and parenteral nutritional support, was provided. On the third day after the presentation of HPVG, abdominal CT reexamination showed that HPVG had disappeared and the intestinal obstruction was relieved. Repeated blood routine shows a decrease in neutrophil and neutrophil.ConclusionsElderly patients who require long-term EN support should avoid early EN support after TACE, as this can prevent intestinal obstruction and HPVG. If the patient suddenly experiences abdominal pain after TACE, CT scan should be performed in a timely manner to determine whether there is intestinal obstruction and HPVG. If the above type of patient experiences HPVG, conservative treatments such as early gastrointestinal decompression, fasting, and anti-infection treatment can be provided first without high-risk factors.