MỘT SỐ ĐẶC ĐIỂM HÌNH ẢNH LIÊN QUAN ĐẾN HOẠI TỬ RUỘT Ở BỆNH NHÂN CÓ KHÍ TĨNH MẠCH CỬA TRÊN CẮT LỚP VI TÍNH

Abstract

Portal venous gas (PVG) is a rare radiological finding, with an ultrasound detection rate of approximately 0.005%. Although infrequent in clinical practice, its presence often indicates severe underlying conditions, particularly bowel ischemia, a life-threatening emergency. Diagnosing bowel ischemia remains challenging due to its rapid progression and the lack of specific clinical signs. Some patients may present with mild or even no symptoms. The decision between surgical and conservative treatment in cases of portal venous gas depends heavily on identifying the underlying cause. However, determining the etiology based on imaging, clinical presentation, and laboratory results is often uncertain, especially in elderly patients. Therefore, we conducted a retrospective study of cases with portal venous gas identified on computed tomography (CT) scans to evaluate imaging features associated with bowel necrosis. Methods: We conducted a retrospective case series analysis of patients diagnosed with PVG on CT imaging over five years (2020–2025). Results: 27 patients were identified with PVG on CT, with females accounting for 59% of cases. The most common underlying cause was bowel necrosis (63%), followed by gastrointestinal perforation (14.8%), enteritis (7.4%), bowel obstruction (3.7%), appendicitis (3.7%), post-radiofrequency ablation (RFA) of the liver (3.7%), and unknown etiology (3.7%). CT findings such as pneumatosis, linear pattern of pneumatosis, and poor bowel wall enhancement were significantly associated with bowel necrosis. Conclusion: PVG is a rare but critical imaging sign on CT. Its etiologies are diverse, with bowel necrosis being the most prevalent. In some cases, the underlying cause remains undetermined even after exploratory laparotomy. CT findings such as pneumatosis, linear pattern of pneumatosis, and poor bowel wall enhancement were associated with bowel ischemia