DOI: 10.36347/sjmcr.2019.v07i07.011

Pages: 438-440

Introduction: The portal vein gas is a radiological sign that corresponds to the presence of area in the portal system. It is a rare entity associated with high mortality. Its main cause is intestinal necrosis. Other etiologies have been reported in the literature. We report an exceptional case of hepatic portal vein secondary to an appendicular abscess. Observation: 54-year-old patient, diabetic on oral antidiabetic drugs, admitted to the emergency department for abdominal pain with fever. The examination found a fever at 39° C, unstable hemodynamic state. The abdominal examination was found defense of the right iliac fossa. Biology confirmed the infectious syndrome, with functional renal failure, normal lactatemia. After conditioning, the abdominal-pelvic CT scan which revealed a collection in the right iliac fossa with an inflamed and sterolithe appendix, and portal vein gas. The vascular axes and the digestive wall were well opacified. The patient was admitted to the operative room. A laparotomy was performed. The exploration found an appendiceal abscess with a perforated gangrene appendicitis, intestine had a normal appearance without evidence of ischemia. The patient had an intraoperative cardiopulmonary arrest and died as a result of septic shock. Conclusion: The intestinal necrosisis the first diagnosis to discuss in front of an portal vein gas, nevertheless, other etiologies although they are less frequent must not be ignored. A good knowledge of the physiopathological mechanism of the portal vein gas allows to consider other non-surgical differential diagnosis.