Pneumatosis intestinalis and hepatic portal venous gas on computed tomography – a non-lethal outcome

The combination of pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) is a rare but important radiological sign. HPVG in isolation has been reported in severe cases of inflammatory or infective colitis, and after colonoscopy, barium enema, abdominal trauma and liver transplant and does not always require intervention. Abdominal radiograph or computed tomography (CT) findings of isolated pneumatosis intestinalis can be due to a variety of causes like coeliac disease, chronic obstructive pulmonary disease and post-organ transplants, but when seen in combination with HPVG is most frequently secondary to bowel ischaemia. Traditionally this is regarded as a pre-morbid sign but the increasing use of CT, which is more sensitive than plain radiograph, has resulted in earlier and increased detection of both PI and HPVG. This report presents the case of a 66-year-old man who had CT evidence of both PI and HPVG with a non-lethal outcome.