Hepatic portal venous gas (HPVG) is rare with high mortality. There are few reports on HPVG's association with
appendicitis. Here we report a case of HPVG associated with
appendicitis. Case presentation: A 79-year-old man presented with acute
abdominal pain. Physical examination suggested peritoneal irritation. Blood tests indicated acute
inflammation,
metabolic acidosis, renal dysfunction and
disseminated intravascular coagulation. Contrast-enhanced abdominal computed tomography revealed HPVG, a contrast defect in the small intestine, and minor
ascites around the intestine. Urgent
laparotomy was performed as intestinal
ischemia was suspected. There were no findings of intestinal
ischemia, but the appendix was discolored with wall thickening. We confirmed a clinical diagnosis of
peritonitis caused by gangrenous
appendicitis. We performed
appendectomy and abdominal drainage. After surgery, the patient needed
intensive care for
septic shock. He left the ICU 7 days after the surgery and was discharged 10 days later. Conclusion: Thus,
appendicitis may cause HPVG.