Hepatic portal venous gas associated with rapid infusion of postoperative early enteral nutrition after radical total gastrectomy

Hepatic portal venous gas (HPVG) is a rare and severe imaging manifestation for surgeons, and it may require emergency surgery. We report an unusual case of HPVG in association with the drip rate of enteral nutrition (EN) after laparoscopic-assisted radical total gastrectomy with Roux-en-Y reconstruction. A 66-year-old woman with gastric cancer was admitted to our hospital. She was diagnosed with cirrhosis of unknown cause and underwent radical total gastrectomy. The rapid infusion of postoperative early EN caused the intestine to expand quickly and injured intestinal mucosa. Hepatic portal venous gas and pneumatosis intestinalis (PI) were discovered subsequently. Early detection and timely effective intervention eventually and completely cured the patient; meanwhile, we avoided unnecessary exploratory laparotomy. Hepatic portal venous gas and PI after radical total gastrectomy can be cured with careful conservative management; the drip rate of EN should be tightly controlled and monitored during treatment after radical total gastrectomy. (C) 2022 Elsevier Inc. All rights reserved.

Automated summary

Hepatic portal venous gas (HPVG) is a rare and severe manifestation that may require emergency surgery. This case report describes a rare case of HPVG associated with the drip rate of postoperative enteral nutrition. Early detection and timely intervention led to a complete cure, avoiding unnecessary surgery.