Hong Kong Journal of Nephrology
Volume 9, Issue 1 , Pages 41-44, April 2007

Portal Vein Gas in a Diabetic Patient with Gas-forming Pararenal Abscess

Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan

Article Outline

The incidence of portal vein gas (PVG), which used to be an ominous sign of intestinal sepsis, has increased with progressive improvements in imaging modalities. Therefore, the clinical significance of PVG has changed. Emphysematous pyelonephritis (EPN) is a rare, potentially life-threatening and gas-forming infection of the renal parenchyma and/or its surroundings. Gas-forming pararenal abscess presenting with PVG is even rarer. We hereby present the case of a diabetic female with poor glycemic control, who was diagnosed to have EPN and PVG concurrently by computed tomography. She underwent percutaneous catheter drainage (PCD) of the pyelonephritis. Both cultures of blood and pus grew Klebsiella pneumoniae. Her subsequent clinical course was uneventful. In summary, EPN is a rare but potentially fatal urinary tract infection in diabetic patients, and finding PVG on computed tomography can aid in diagnosis. Conservative treatment with intravenous antibiotics and PCD of pus may be adequate for the patient with EPN. However, nephrectomy may be necessary if the patient deteriorates and PCD fails to contain the infection.

Key words:  diabetes mellitus , emphysematous pyelonephritis , pararenal abscess , percutaneous catheter drainage , portal vein gas

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References 

  1. Wolfe JN , Evana WA . Gas in the portal veins of the liver in infants: a roentgenographic demonstration with postmortem anatomical correlation . AJR Am J Roentgenol . 1955;74:486–488
  2. Susman N , Senturia HR . Gas embolization of the portal venous system . Am J Roentgenol Radium Ther Nucl Med . 1960;83:847–850
  3. Huang JJ , Sung JM , Chen KW , Ruaan MK , Shu HF , Chuang YC . Acute bacterial nephritis: a clinicoradiological correlation based on computed tomography . Am J Med . 1992;93:289–298
  4. Graham GA , Berstein RB , Gronner AT . Gas in the portal and inferior mesenteric veins caused by diverticulitis of the sigmoid colon: report of a case with survival . Radiology . 1975;114:601–602
  5. Faberman RS , Mayo-Smith WW . Outcome of 17 patients with portal venous gas detected by CT . AJR Am J Roentgenol . 1997;69:1535–1538
  6. Hong JJ , Gadaleta D , Rossi P , Esquivel J , Davis JM . Portal vein gas, a changing clinical entity: report of 7 patients and review of the literature . Arch Surg . 1997;132:1071–1075
  7. Graffith DM , Gough MH . Gas in the hepatic portal veins . Br J Surg . 1986;73:172–176
  8. Taourel PG , Deneuville M , Pradel JA , Regent D , Brael JM . Acute mesenteric ischemia: diagnosis with contrast-enhanced CT . Radiology . 1996;199:632–636
  9. Merine D , Fishmen EK . Uncomplicated portal venous gas associated with double perforation following ERCP: CT features . J Comput Assist Tomog . 1989;13:138–139
  10. Zhang D , Weltman D , Baykal A . Portal vein gas and colonic pneumatosis after enema, with spontaneous resolution . AJR Am J Roentgenol . 1999;173:1140–1141
  11. Quirke TE . Hepatic-portal venous gas associated with ileus . Am Surg . 1995;61:1084–1086
  12. Brown MA , Hauschildt JP , Casola G , Gosink BB , Hoyt DB . Intravascular gas as incidental finding at US after blunt abdominal trauma . Radiology . 1999;210:405–408
  13. Zielke A , Hasse C , Nies C , Rothmund M . Hepatic-portal venous gas in acute colonic diverticulitis . Surg Endosc . 1998;12:278–280
  14. Yoshida M , Mitsuo M , Kutsumi H , et al.   A successfully treated case of multiple liver abscesses accompanied by portal venous gas . Am J Gastroenterol . 1996;91:2423–2425
  15. Batista J . Therapeutic procedure for tuberculosis thrombophlebitis . Angiologia . 1991;43:165–170
  16. Scheidler J , Stabler A , Kleber G , Neidhardt D . Computed tomography in pneumatosis intestinalis: differential diagnosis and therapeutic consequences . Abdom Imaging . 1995;20:523–528
  17. Huang JJ , Tseng CC . Emphysematous pyelonephritis . Arch Intern Med . 2000;160:797–805
  18. Schainuck LI , Fouty R , Cutler RE . Emphysematous pyelonephritis . Am J Med . 1968;44:134–139
  19. Huang JJ , Chen KW , Ruaan MK . Mixed acid fermentation of glucose as a mechanism of emphysematous urinary tract infection . J Urol . 1991;146:148–151
  20. Yang WH , Shen NC . Gas-forming infection of the urinary tract: an investigation of fermentation as a mechanism . J Urol . 1990;143:960–964
  21. Chen KW , Huang JJ , Wu MH , Lin XZ , Chen CY , Ruaan MK . Gas in hepatic veins: a rare and critical presentation of emphysematous pyelonephritis . J Urol . 1994;151:125–126
  22. Wan YL , Lee TY , Bullard MJ , Tsai CC . Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome . Radiology . 1996;198:433–438

PII: S1561-5413(07)60008-8

doi:10.1016/S1561-5413(07)60008-8

Hong Kong Journal of Nephrology
Volume 9, Issue 1 , Pages 41-44, April 2007

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