Portal venous gas after ingestion of concentrated hydrogen peroxide

INTRODUCTION: Ingestion of concentrated hydrogen peroxide can cause corrosive injury and rapid gas formation, leading to intramural gas and portal venous gas. While portal venous gas reflects intravascular gas formation, its relationship with systemic gas embolism remains uncertain. CASE SUMMARY: A 37-year-old man ingested 50% hydrogen peroxide and presented with vomiting and abdominal distension. Computed tomography demonstrated intramural gas and portal venous gas, and endoscopy showed corrosive injury. Hyperbaric oxygen therapy was initiated but was not completed initially. Repeat imaging demonstrated persistent intramural gas, and a second hyperbaric oxygen therapy session was performed. Follow-up imaging demonstrated complete resolution. IMAGES: Serial computed tomography imaging demonstrated intramural gas and portal venous gas at presentation, persistence at six hours, and complete resolution on follow-up imaging. CONCLUSION: Hydrogen peroxide ingestion may result in corrosive injury and extensive portal venous gas. Early imaging and endoscopic assessment are important, and hyperbaric oxygen therapy may be considered in selected patients.