Computed tomography-detected portal venous gas managed conservatively: a case series emphasising clinical-radiological correlation

Abstract

Portal venous gas (PVG), historically considered a critical radiological finding associated with life-threatening conditions such as mesenteric ischemia and sepsis, and often prompting urgent surgical intervention, is increasingly recognised in a wider spectrum of clinical scenarios with the advent of high-resolution computed tomography (CT). This case series describes three patients in whom PVG was identified on CT and successfully managed without surgery, with underlying causes including sepsis from a urinary source with gas-forming organisms, gastric distention with pneumatosis, and suspected ischemic colitis in the setting of preserved hemodynamic stability. All patients were treated conservatively with intravenous antibiotics and demonstrated favourable outcomes, underscoring the importance of interpreting PVG as a radiological sign rather than an automatic surgical indication. Clinical context, hemodynamic stability, laboratory findings, and adjunctive investigations remain central to guiding management, and recognition of benign or iatrogenic causes is essential to avoid unnecessary operative interventions.