Gastrointestinal
Gastrointest Radiol 4, 163-164 (1979)
Radiology
Portal Vein Gas Following Air-Contrast Barium Enema in Granulomatous Colitis: Report of a Case V i j a y K. S a d h u , R i c h a r d E. B r e n n a n , a n d V i j a y M a d a n Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
Abstract.
Portal vein gas developed in a patient with granulomatous colitis following air-contrast barium enema. No symptomatology or morbidity could be attributed to the portal vein gas in this patient.
Key words: P o r t a l litis -
venous gas - Granulomatous coA i r - c o n t r a s t b a r i u m e n e m a , c o m p l i c a t i o n s of.
We report here a case of hepatic portal venous gas (HPVG) following air-contrast barium enema in a p a t i e n t w i t h g r a n u l o m a t o u s colitis. T o o u r k n o w l e d g e this has not been previously reported.
Case Report A 64-year-old white female was referred for barium enema examination. She had lost 30 pounds over the last year and complained of chronic diarrhea. Through a plastic disposable tip, a thick suspension of barium sulfate was introduced to the region of the hepatic flexure. Following removal of excess barium, air was introduced via manual pressure on the air-filled bag and the routine radiographs were taken. While we were reviewing the radiographs at the completion of the .examination, HPVG was discovered (Fig. 1). This was not present on the scout radiograph. The colon was diffusely abnormal with mucosal ulcerations throughout, including the rectum (Fig. 2). The patient then denied abdominal pain or discomfort. Vital signs were normal, She was admitted for observation. Blood cultures performed immediately and 24 h after the barium enema showed no growth of aerobic or anaerobic organisms. A transfusion of 2 units of packed red blood cells was given because of microcytic anemia of 7.5 g of hemoglobin. Thereafter, temperature rose to 38~ (101 ~ F), but again blood cultures were negative. No antibiotics were given. No HPVG was seen on an abdominal radiograph performed 24 h after the barium Address reprint req~wst to: Vijay Sadhu, M.D., Department of
Radiology, Hermann Hospital, 1203 Ross Sterling, Houston, TX 77030, USA
Fig. 1. Radiograph of hepatic flexure from the double-contrast barium enema study demonstrating gas in the portal venous system
enema. Barium meal examination several days later revealed granulomatous involvement of the distal small bowel (Fig. 3). Colonoscopy findings were compatibIe with granulomatous colitis. Subsequent hospital course was uneventful and the patient was discharged.
9
0364-2356/79/0004-0163 $01.00 1979 S p r i n g e r - V e r l a g N e w Y o r k Inc.
164
V.K. Sadhu et al. : Portal Vein Gas in G r a n u l o m a t o u s Colitis
Fig. 2. Radiograph from same study. Note loss of haustrations and diffuse ulcerations. H P V G can be seen in the right upper quadrant
Discussion
Three previous case reports have documented the association of H P V G and barium enema examination in ulcerative colitis. In 1965, Lazar [1] reported H P V G and pneumoperitoneum during air-contrast barium enema in a patient with chronic ulcerative colitis. Abdominal pain and vomiting occurred immediately with free perforation. Antibiotics and intravenous fluids were administered, but the hospital course was uneventful, except for slight elevation of the white blood cell count. Weinstein et al. [2] documented H P V G following barium enema in a second patient with chronic ulcerative colitis. These authors were uncertain whether the H P V G occurred during the cleansing enema or during the barium enema. Antibiotics were given and the patient recovered. The third case of H P V G secondary to barium enema in ulcerative colitis was reported by Kees and Hester in 1972 [3]. Their patient was noted to have H P V G on two separate double-contrast enemas about 1 year apart. The authors felt neither episode of H P V G altered the patient's clinical course. N o antibiotics were administered. Fred et al. [4] felt that H P V G occurring with barium enema in colitis results from a combination of mucosal ulceration and increased intraluminal pressure. We feel there is basically no difference in the
Fig. 3. Radiograph of small bowel from barium meal reveals characteristic changes of C r o h n ' s disease
pathogenesis of the H P V G in our patient with granulomatous ileocolitis and those previously reported with ulcerative colitis. Based on our case and those previously reported, H P V G in this setting probably does not cause patient symptoms unless associated with free perforation; and does not appear to be associated with patient morbidity.
References 1. Lazar HP: Survival following portal venous air embolization: Report of a case. Am J Dig Dis 10:259~64,1965 2. Weinstein GE, Weiner M, Schwartz M: Portal vein gas. Am J Gastroenterol 49.'425 429, 1968 3. Kees C J, Hester CL, Jr: Portal vein gas following barium enema exam. Radiology 102:525-526, 1972 4. Fred HL, Mayhall CG, Harle TS: Hepatic portal venous gas: A review and report on six new cases. Am J Med 44:557-565, 1968
Received: July 31, 1978; accepted: August 28, 1978
Gastrointest Radiol 4, 163-164 (1979)
Radiology
Portal Vein Gas Following Air-Contrast Barium Enema in Granulomatous Colitis: Report of a Case V i j a y K. S a d h u , R i c h a r d E. B r e n n a n , a n d V i j a y M a d a n Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
Abstract.
Portal vein gas developed in a patient with granulomatous colitis following air-contrast barium enema. No symptomatology or morbidity could be attributed to the portal vein gas in this patient.
Key words: P o r t a l litis -
venous gas - Granulomatous coA i r - c o n t r a s t b a r i u m e n e m a , c o m p l i c a t i o n s of.
We report here a case of hepatic portal venous gas (HPVG) following air-contrast barium enema in a p a t i e n t w i t h g r a n u l o m a t o u s colitis. T o o u r k n o w l e d g e this has not been previously reported.
Case Report A 64-year-old white female was referred for barium enema examination. She had lost 30 pounds over the last year and complained of chronic diarrhea. Through a plastic disposable tip, a thick suspension of barium sulfate was introduced to the region of the hepatic flexure. Following removal of excess barium, air was introduced via manual pressure on the air-filled bag and the routine radiographs were taken. While we were reviewing the radiographs at the completion of the .examination, HPVG was discovered (Fig. 1). This was not present on the scout radiograph. The colon was diffusely abnormal with mucosal ulcerations throughout, including the rectum (Fig. 2). The patient then denied abdominal pain or discomfort. Vital signs were normal, She was admitted for observation. Blood cultures performed immediately and 24 h after the barium enema showed no growth of aerobic or anaerobic organisms. A transfusion of 2 units of packed red blood cells was given because of microcytic anemia of 7.5 g of hemoglobin. Thereafter, temperature rose to 38~ (101 ~ F), but again blood cultures were negative. No antibiotics were given. No HPVG was seen on an abdominal radiograph performed 24 h after the barium Address reprint req~wst to: Vijay Sadhu, M.D., Department of
Radiology, Hermann Hospital, 1203 Ross Sterling, Houston, TX 77030, USA
Fig. 1. Radiograph of hepatic flexure from the double-contrast barium enema study demonstrating gas in the portal venous system
enema. Barium meal examination several days later revealed granulomatous involvement of the distal small bowel (Fig. 3). Colonoscopy findings were compatibIe with granulomatous colitis. Subsequent hospital course was uneventful and the patient was discharged.
9
0364-2356/79/0004-0163 $01.00 1979 S p r i n g e r - V e r l a g N e w Y o r k Inc.
164
V.K. Sadhu et al. : Portal Vein Gas in G r a n u l o m a t o u s Colitis
Fig. 2. Radiograph from same study. Note loss of haustrations and diffuse ulcerations. H P V G can be seen in the right upper quadrant
Discussion
Three previous case reports have documented the association of H P V G and barium enema examination in ulcerative colitis. In 1965, Lazar [1] reported H P V G and pneumoperitoneum during air-contrast barium enema in a patient with chronic ulcerative colitis. Abdominal pain and vomiting occurred immediately with free perforation. Antibiotics and intravenous fluids were administered, but the hospital course was uneventful, except for slight elevation of the white blood cell count. Weinstein et al. [2] documented H P V G following barium enema in a second patient with chronic ulcerative colitis. These authors were uncertain whether the H P V G occurred during the cleansing enema or during the barium enema. Antibiotics were given and the patient recovered. The third case of H P V G secondary to barium enema in ulcerative colitis was reported by Kees and Hester in 1972 [3]. Their patient was noted to have H P V G on two separate double-contrast enemas about 1 year apart. The authors felt neither episode of H P V G altered the patient's clinical course. N o antibiotics were administered. Fred et al. [4] felt that H P V G occurring with barium enema in colitis results from a combination of mucosal ulceration and increased intraluminal pressure. We feel there is basically no difference in the
Fig. 3. Radiograph of small bowel from barium meal reveals characteristic changes of C r o h n ' s disease
pathogenesis of the H P V G in our patient with granulomatous ileocolitis and those previously reported with ulcerative colitis. Based on our case and those previously reported, H P V G in this setting probably does not cause patient symptoms unless associated with free perforation; and does not appear to be associated with patient morbidity.
References 1. Lazar HP: Survival following portal venous air embolization: Report of a case. Am J Dig Dis 10:259~64,1965 2. Weinstein GE, Weiner M, Schwartz M: Portal vein gas. Am J Gastroenterol 49.'425 429, 1968 3. Kees C J, Hester CL, Jr: Portal vein gas following barium enema exam. Radiology 102:525-526, 1972 4. Fred HL, Mayhall CG, Harle TS: Hepatic portal venous gas: A review and report on six new cases. Am J Med 44:557-565, 1968
Received: July 31, 1978; accepted: August 28, 1978
