PMC7519867_01
Plain chest (A) and abdominal (B) radiograph showing subphrenic free air (white arrow) and hepatic portal venous gas (arrowhead).
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A plain chest and abdominal film showed subphrenic free air and an unremarkable bowel gas pattern (Figure 1).
Contrast-enhanced computed tomography showing extensive portal venous gas of the entire liver (white arrow). Axial (A) and coronal (B) view.
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A CT scan revealed a pneumoperitoneum in the right upper quadrant, pneumoretroperitoneum, and gas in the entire portal venous system, without bowel wall thickening, bowel dilatation, bowel perforation, intramural gas, or any abnormal findings in the mesenteric arteries (Figure 2).
Follow-up plain abdominal radiograph (A) and esophagogastroduodenoscopy (B). The subphrenic free air and hepatic portal venous gas identified in the initial study had almost resolved. Esophagogastroduodenoscopy showed no abnormal findings.
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On admission day 3, the follow-up simple erect abdominal X-ray revealed resolving free air (Figure 3A), and no new symptoms appeared. Oral feeding was initiated, after confirming that there were no abnormalities on esophagogastroduodenoscopic examination (Figure 3B).
Colonoscopy (A), follow-up computed tomography (CT) scan (B), and colonography protocol CT scan (C and D), performed two weeks after discharge, showed no significant abnormalities.
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The follow-up CT scan, performed two weeks after discharge, showed that the diffuse air density in the portal venous system, the pneumoperitoneum, and the pneumoretroperitoneum had resolved, and the colonoscopy and the colonography protocol CT scan revealed no significant abnormalities (Figure 4).