Transient Extensive Portal Venous Gas in a Dialysis Patient

Hepatic portal venous gas (HPVG) is a serious radiologic indicator that can suggest bowel ischemia and lead to fatal outcomes. The medical field now identifies transient HPVG without ischemia more often because CT technology has spread throughout the healthcare system. We report a 70-year-old woman with end-stage renal disease (ESRD) on hemodialysis who developed acute abdominal pain during dialysis. The CT scan results showed HPVG extending into the superior mesenteric venous system. The medical team performed an urgent diagnostic laparoscopy because of ischemia concerns, which showed that the bowel tissue remained healthy without signs of necrosis or perforation. She improved clinically with supportive care, and at 48 hours, a repeat CT showed complete resolution of HPVG. The case illustrates that medical imaging results need to match clinical observations and surgical findings to determine which patients can receive nonsurgical treatment.