1. Hepatic Portal Venous Gas : Is it definitely a surgical indication?
Mai Chen-Ming1, Lin An-Jen1, Huang Shin-Wei1, Lin Chien-Hua2, Ou Jing-Jim2, Lee Yueh-Tsung2, Tsai Zhi-Hong1, Hsu Hong2
1Division of General Surgery, Show Chwan Health Care System Show Chwan Memorial Hospital, 2Division of General Surgery, Show Chwan Health Care System Chang-Bing Show Chwan Memorial Hospital

2. Case Presentation 70-year-old man
Complain : abdominal cramping pain, constipation and vomiting for 1 day.
Past History : diabetes mellitus and perforated peptic ulcer for 20 years
P.E of abdomen: distended abdomen with tenderness ,no rebounding tenderness

3. Vital sings : pulse rate 86/min, blood pressure 128/76 mmHg, respiratory rate 22/min, temperature 36.2°C
Laboratory data: WBC : 14460/uL , glucose: 234 mg/dL
Treatment: imipenem/cilastatin (500 mg q6h)

4. Discussion intestinal wall alteration bowel distention
infection and sepsis
Kevin McElvanna. Ulster Med J 2012;81:74-78
Hussain A. World J Emerg Surg 2008;3:21.

5. Conclusion
The finding of HPVG itself is not a definite indication of operation.
Finding the underlying problem and consideration of patient's clinical presentation are most important for decision-making.