Kairavee Dave, MD, Vivek Choksi, MD, Rulz T. Cantave, MD, Sufian J. Sorathia, Steven R. Kaplan, MD, FACG
Aventura Hospital and Medical Center, Aventura, FL
Introduction: Gas in the gastric venous system or the portal venous system is a critical finding and can be from a life threatening abdominal catastrophe as well as from benign conditions.
Case Description/Methods: A 52 year old gentleman presented with nausea, vomiting and diarrhea for 2 days. He had multiple episodes of non bloody diarrhea for past two days and had an episode of vigorous non bilious/ non bloody vomiting. No fevers, chills or weight loss was reported. His medical history included diabetes mellitus type 2, hypertension, obstructive sleep apnea, depression and anxiety. On admission, his vitals were stable. The physical examination was completely benign. His laboratory data revealed mild leukocytosis of 13.3. Lactate was normal. There was no anemia or microcytosis. A CT scan of his abdomen was done which revealed gas in the gastric veins and the peri-gastric veins, which was very concerning. Urgent Surgical consultation was placed. The patient was admitted to step down unit and conservative management with hydration, anti emetics and supportive care was initiated. In the next 4 hours, the patient started feeling better and became asymptomatic. The CT of the abdomen was repeated. The entire patient care team was on high alert for a possible abdominal catastrophe/ischemia and need for emergent surgery. The repeat CT scan was done 6 hours later which revealed linear lucencies within the peripheral aspect of the left lobe of the liver, consistent with gas within the portal venous system. Urgent Infectious Disease consultation was called and piperacillin-tazobactam was initiated. At this time, the patient was asymptomatic, his vitals were stable, the lactate remained normal and the leukocytosis had resolved in the repeat laboratory analysis. Close monitoring was continued. The next day, the patient remained in the stable and asymptomatic. A third repeat CT scan of the abdomen revealed complete resolution of all the gas in the gastric and the portal venous system. The diet and activity were advanced gradually and the patient was discharged the same day.
Discussion: It is important to recognize that there are many benign causes of gastric venous gas and portal venous gas such as gastroenteritis. We believe that the mechanical trauma of retching and vigorous vomiting may have lead to this finding.
Citation: Kairavee Dave, MD, Vivek Choksi, MD, Rulz T. Cantave, MD, Sufian J. Sorathia, Steven R. Kaplan, MD, FACG. P1804 - A SCARY CASE OF GASTROENTERITIS. Program No. P1804. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.