Hepatic Portal Venous Gas in the Babies

Hepatic portalvenous gas (HPVG) - rare ultrasound phenomenon, previously frequently associated with acute mesenteric ischemia and/or necrosis, and accompanied by high mortality (up to 75-90%). HPVG phenomenon was described in 1955 the baby with necrotic enterocolitis, and early studies of HPVG were based on plain abdominal radiography. Modern abdominal CT and ultrasound examination USE has resulted in the detection of HPVG in more benign conditions, and in more diverse diseases and in twenty-first century mortality when it is less than 40%. Purpose: to evaluate differents variants sonographic patterns of the HPVG-phenomenon and their diganostics value. Materials and methods. A total of 33 babies with HPVG, who visited our hospital between 2005 and 2014 were analyzed. Results. Identified 2 sonographic patterns HPVG depending on its generation. When transportal pattern the gas flow after performing manipulations on the vessels of the umbilical cord (5/33, all children 1-4 days), gas was detected only in the left branches of the portal vein, in 1 case the child had severe heart failure associated, presumably, with gas embolism of the pulmonary artery. In other cases (28/33, 25 newborns and 3 babies (7 months with enterocolitis, 9 months with midgut volvulus and 24 months with intestinal infection) occurred transportal the gas flow. The gas bubbles were detected in all parts of the liver parenchyma and in the lumen of the portal vein. In the 25 newborns 12 cases, the HPVG was observed on the background of necrotizing enterocolitis, 3 newborn - intestinal obstruction and in 10 cases of HPVG was observed on the background of deterioration in patients without a clear clinical picture. In these cases, the sonographic detection of HPVG conventionally been regarded as the risk of developing septic shock. In 1 case the child 7 months with liver cirrhosis and recanalization of the umbilical vein HPVG was complicated portosystemic gas shunting into the inferior vena cava and right heart embolism. In the article showing the various patterns of visualization HPVG. The duration of HPVG existence which only 1 case was 1 day, the remaining estimated hours. It is urgent need to differentiate HPVG from gas in the hepatic veins. Literature of this rare condition is reviewed briefly Conclusion. Sonographic representation of the HPVG depending on its origin. The transportal HPVG can be interpreted as a predictor of enterocolitis and/or sepsis. The transumbilical HPVG in newborns may be accompanied by gas embolism of the lungs.

ультразвуковая диагностика, газ портальной системы, младенцы, ultrasonography, hepatic portal venous gas, babies

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