A Rare Case of Radiochemotherapy - Induced Pneumatosis Intestinalis and Hepatic Portal Venous Gas in an Asymptomatic Patient

Cheong J, Nicolle C and Sgroi A

Department of Surgery, Groupement Hospitalier de l’Ouest Lémanique (GHOL), Nyon Hospital, Switzerland

^*Correspondance to: Julia Cheong 

 PDF  Full Text DOI: 10.25107/2474-1647.3671

Abstract

Background: Pneumatosis Intestinalis (PI) is an infrequent radiological finding described as the presence of intramural gas located either in the small or large bowel, with radiochemotherapy known to be one of the rare causative agents. Hepatic Portal Venous Gas (HPVG) can in some cases be associated with PI. Both PI and HPVG can indicate the presence of severe life-threatening intra-abdominal pathology such as intestinal perforation, ischemia, obstruction or volvulus in symptomatic patients. Case Report: A 73-year-old man, recently diagnosed with localized lower esophageal carcinoma and undergoing combined radiochemotherapy, presented with mild abdominal discomfort. Clinical examination, vital signs and laboratory tests were unremarkable and reassuring. Abdominal CT scan showed PI, HPVG and pneumoperitoneum. Given the patient’s reassuring clinical status, he was managed conservatively as an outpatient and regularly followed up. Subsequent repeat CT scans showed spontaneous and complete resolution of PI, HPVG and pneumoperitoneum. The patient thereafter completed his neoadjuvant chemotherapy regimen with no complications and later underwent an Ivor-Lewis esophagectomy. Discussion: PI associated with HPVG can result in a fatal outcome in symptomatic patients if not identified promptly and managed properly. We herein report a rare case of radiochemotherapyinduced PI with HPVG in an asymptomatic patient. Although most cases can be managed conservatively, emergency exploratory laparoscopy or laparotomy should not be delayed if bowel ischemia is clinically suspected in presence of PI and HPVG.

Keywords

Pneumatosis intestinalis; Hepatic portal venous gas; Radiochemotherapy; Esophageal cancer

Cite the article

Cheong J, Nicolle C, Sgroi A. A Rare Case of Radiochemotherapy - Induced Pneumatosis Intestinalis and Hepatic Portal Venous Gas in an Asymptomatic Patient. Clin Surg. 2023; 8: 3671..