• Minjia Wang, Jia Song, Shijin Gong, Yihua Yu, Weihang Hu, and Yueben Wang.
• Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, PR China.
• Medicine (Baltimore). 2020 Apr 1; 99 (17): e19810.

IntroductionHepatic portal venous gas (HPVG) is a rare imaging finding. When HPVG is accompanied with pneumatosis intestinalis (PI), the underlying cause is usually mesenteric ischemia with consequent intestinal necrosis. This combination of clinical conditions is associated with a poor prognosis. In this study, we present the cases of 2 elderly patients with HPVG and PI secondary to mesenteric ischemia.Patient ConcernsIn case 1, a 89-year-old male patient was admitted to intensive care unit with respiratory failure, On the fifth day of admission, he developed a high fever (39.5°C) and abdominal distension. In case 2, a 92-year-old male patient admitted to our intensive care unit and received mechanical ventilation due to acute respiratory failure. During the treatment, the patient developed gastrointestinal bleeding. On physical examination, abdominal bulging and tense abdominal walls were detected. Both patients underwent abdominal contrast-enhanced computed tomography, showed abundant HPVG with PI.DiagnosesThe patients were diagnosed as acute mesenteric ischemia, bowel necrosis, septic shock, multiple organ dysfunction syndrome based on computed tomography scan, abdominal signs, and laboratory tests.InterventionsFluid resuscitation, high-dose vasopressors, and intravenous antibiotic therapy were given.OutcomesDespite prompt treatment, the condition of both patients rapidly deteriorated, and the patients died shortly thereafter.ConclusionMesenteric ischemia is a clinical emergency. In patients with risk factors and abdominal signs, the clinical suspicion for this condition should be high. Although rare, both HPVG and PI are important radiological clues that usually indicate the presence of mesenteric ischemia with consequent intestinal necrosis.

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