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Plain abdominal radiograph of a 60-year-old woman with progressive periumbilical pain and abdominal distention of three days’duration.
The radiographic hallmark of this condition is a spidery pattern of tubular radiolucencies branching toward the liver edge (imagebelow). Gas in the biliary tract is located more centrally and may appear in the gallbladder and extrahepatic biliary ducts as well.
Hepatic portal venous gas usually indicates necrotic bowel in adults and necrotizing enterocolitis in infants. Emergencyceliotomy in this patient demonstrated gangrene of the jejunum and gas in the portal vein. Blood cultures grew Klebsiella and Enterococcus species. The patient died 10 days after surgery.
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