Case Report - Portal venous gas during chemotherapy

A 56-year-old woman was admitted to our hospital with abdominal pain, nausea and diarrhea. She had previously operated for the ceacal cancer and performed chemotherapy with 5-fluorouracil (5-FU) and leucovorin (LV) after operation. She restarted chemotherapy with 5-FU and LV three weeks before, because size-up paraaortic lymphnode, lung metastasis and ovarian metastases were noted by follow-up CT scan. On physical examination at admission, mild tenderness located in the upper umbilicus was found. Blood examination showed leucocytopenia and neutropenia and C reactive protein level was slightly elevated. Under a diagnosis of enteritis as an adverse event of chemotherapy, conservative therapy including fasting and resuscitation was instituted. One day after admission, a high-grade fever was observed. A computed tomography (CT) of the abdomen showed portal venous gas (PVG). We did not suspect necrosis of the bowels and conservative therapy was continued. Follow-up CT imaging a day after revealed a disappearance of the PVG. It is believed that the radiographic detection of PVG is a life-threatening sign, but many of these cases do not require exploratory laparotomy. Contrast-enhanced CT should be performed to avoid unnecessary laparotomy.