Portal pneumatosis by ultrasonography associated with Severe Acute Pancreatitis

Importance of differential diagnosis of portal pneumatosis cases

Abstract

Introduction: Portal pneumatosis (PN) is the accumulation of gas in the hepatic portal vein or its branches, initially observed in neonates with necrotizing enterocolitis. In adults, the main causes include intestinal pneumatosis and mesenteric ischemia, the latter associated with high mortality and the need for emergency laparotomy, according to the literature. Case report: A 74-year-old male patient was admitted to the General Hospital of Luque in April 2024 with abdominal pain of abrupt onset, located in the epigastrium, accompanied by nausea. After a detailed clinical history, physical examination and complementary studies, mesenteric ischemia was initially suspected due to the presence of portal pneumatosis on abdominal ultrasound. In addition, laboratory tests showed elevated amylase and lipase, leading to a final diagnosis of severe acute pancreatitis. Initial treatment included hydration, pain control, administration of antibiotics and anticoagulants. Despite the suspicion of intestinal ischemia, clinical and laboratory findings eventually pointed to acute pancreatitis. Subsequent ultrasound showed signs of an alliased gallbladder and other findings suggestive of an abdominal inflammatory process. A subsequent CT scan confirmed pancreatic inflammation without evidence of portal pneumatosis. ...