Differentiating hepatic portal vein gas from pneumobilia

Overview With a mortality rate of 39%, Hepatic Portal Vein Gas remains an ominous sign for a patient's prognosis. Yet for junior doctors and surgical trainees, it is important to differentiate pneumobilia from Hepatic Portal Vein Gas, the former carrying a far more positive prognosis. The differentiation between the relatively benign finding of pneumobilia and hepatic portal venous gas is essential to optimize patient management. Although pneumobilia must be thoroughly investigated, in general, it carries a far more favourable prognosis. Historically, hepatic portal venous gas was a harbinger of a major abdominal catastrophe, namely mesenteric infarction, and warranted urgent surgical intervention. However, with the advent of high resolution CT scanners, some less critical conditions have been shown to manifest this sign, and it is thus crucial for the optimal management of these patients that these conditions be differentiated.