Clinical Report: Intraoperative Decision-Making for Portal Venous Gas

Overview

This case series evaluates surgical decision-making in patients with portal venous gas (PVG) and acute abdomen, comparing definitive resection to damage control observation based on intraoperative intestinal viability.

Background

Portal venous gas (PVG) is often associated with serious intestinal pathology and has historically indicated high mortality rates. Accurate assessment of intestinal viability during surgery is essential for determining the appropriate surgical intervention, whether it be resection or preservation of bowel segments.

Data Highlights

Key Findings

• All patients presented with acute abdominal pain and preoperative CT showed PVG with intestinal abnormalities.
• In the definitive resection group, bowel necrosis involved significant lengths of jejunum or ileum, treated by resection and anastomosis.
• Patients in the damage control observation group experienced more pronounced postoperative inflammatory and coagulation abnormalities.
• One patient in the observation group had a D-dimer level of 5.45 bcg/mL and required ICU admission.
• All patients survived to discharge.

Clinical Implications

Intraoperative assessment of bowel viability is critical in managing patients with PVG and acute abdomen.

Conclusion

This case series highlights the importance of intraoperative decision-making in the management of PVG.

Related Resources & Content

1. World Society of Emergency Surgery, 2022 -- Acute mesenteric ischemia: updated guidelines
2. Surgical Endoscopy, 2025 -- Surgical Management of Intraabdominal Sepsis: Utilizing a Damage Control Strategy to Lower Stoma Formation Rates
3. Frontiers in Medicine, 2026 -- Clinical phenotypes and imaging evolution of hepatic portal venous gas under conservative management
4. European Radiology — Technical Insights on Percutaneous Recanalization for Non-Cirrhotic Extrahepatic Portal Vein Obstruction in Pediatric Patients: Findings from an Initial Cohort Study
5. Portal vein cavernous transformation in pancreatic cancer surgery: prioritizing venous bypass grafting
6. Managing acute mesenteric ischaemia | Intensive Care Medicine
7. The open abdomen in trauma and non-trauma patients: WSES guidelines
8. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery
9. Radiological predictive factors of transmural intestinal necrosis in acute mesenteric ischemia: systematic review and meta-analysis - PubMed
10. Outcomes of patients with pneumatosis intestinalis and/or portal venous gas: a study of factors associated with survival and surgical intervention - Wong - 2024 - ANZ Journal of Surgery - Wiley Online Library
11. Identification of CT features and laboratory indicators to aid in the management of patients with portal venous gas identified on imaging - PubMed