Hepatic portal vein gas without bowel infarction or necrosis.

Spontaneously developing intrahepatic portal vein gas is usually associated with necrotic bowel, bacteremia, or both. Very few patients with this radiographic sign survive. A postoperative patient with severe abdominal pain and distention was found to have hepatic portal vein gas. At exploration two intraperitoneal abscesses were found and drained. The bowel was unremarkable. The patient had an uncomplicated postoperative course. Abscesses have not been associated with the development of intrahepatic portal vein gas. It is rare for this "diagnostic sign" not to be associated with necrotic bowel and a very bad prognosis.