Hepatic portal venous gas without definite clinical manifestations of necrotizing enterocolitis in a 3-day-old full-term neonate: A case report

Abstract

Background: Neonatal hepatic portal venous gas (HPVG) is associated with a high risk of necrotizing enterocolitis (NEC) and was previously believed to be associated with an increased risk of surgery.

Case summary: A 3-day-old full-term male infant was admitted to the pediatrics department after presenting with "low blood glucose for 10 min". Hypoglycemia was corrected by intravenous glucose administration and oral breast milk. On the 3^rd d after admission, an ultrasound examination showed gas accumulation in the hepatic portal vein; this increased on the next day. Abdominal vertical radiograph showed intestinal pneumatosis. Routine blood examination showed that the total number of white blood cells was normal, but neutrophilia was related to age. There was a significant increase in C-reactive protein (CRP). The child was diagnosed with neonatal NEC (early-stage). With nil per os, rehydration, parenteral nutritional support, and anti-infection treatment with no sodium, his hepatic portal vein pneumatosis resolved. In addition, routine blood examination and CRP examination showed significant improvement and his symptoms resolved. The patient was given timely refeeding and gradually transitioned to full milk feeding and was subsequently discharged. Follow-up examination after discharge showed that the general condition of the patient was stable.

Conclusion: The presence of HPVG in neonates indicates early NEC. Early active anti-infective treatment is effective in treating NEC, minimizes the risk of severe NEC, and reduces the need for surgery. The findings of this study imply that early examination of the liver by ultrasound in a sick neonate can help with the early diagnosis of conditions such as NEC.

Keywords: Case report; Clinic; Early diagnosis; Hepatic portal venous gas; Neonates; Ultrasound.

Figure 1

On the 3^rd day after birth, hepatic portal venous gas was found by ultrasound. A: Extensive pneumatosis in the portal vein was found by B-ultrasound; B: Bubble rising in hepatic portal vein was found by B-ultrasound.

Figure 2

On the 3^rd day after birth, abdominal X-ray showed that the intestinal tube was inflated, there was no obvious sign of gas separation downstream of the diaphragm, and there was no obvious gas-liquid level.

Figure 3

After 3 d of treatment, chest abdominal X-ray showed that the intestinal inflation was slightly improved.

Figure 4

After 4 d of treatment, liver ultrasound showed that hepatic portal venous gas disappeared completely.