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Zouheir Ibrahim Bitar
Ahmadi Hospital, Kuwait
Posters & Accepted Abstracts: Gen Surg: Open Access
Introduction: Portal venous gas could be rarely found in adults and is typically associated with underlying intestinal ischemia. Portal venous gas can be detected by a bedside point of care ultrasound (POCUS) examination in adult patients in critical care units (CCU). Findings include echogenic bubbles flowing centrifugally throughout the portal venous system. Case presentation: We present the case of a 73-year-old female with advanced ischemic cardiomyopathy and cardiorenal syndrome who was managed in the CCU. She developed vague abdominal pain and respiratory depression requiring intubation and dialysis during her course of treatment in the CCU. Her findings were consistent with portal venous gas upon POCUS, prompting computed tomography of her abdomen and surgical consultation. She was ultimately found to have nonobstructive mesenteric ischemia. Clinical discussion: PVG is an ominous radiological sign and reflects intestinal ischemia up to 72% of cases. Occlusive or nonocclusive obstruction of the arterial blood supply or obstruction of venous outflow could be the particular reasons for acute mesenteric ischemia of the small bowel. Nonocclusive obstruction accounts for 5% to 15% of patients with acute mesenteric ischemia. Conclusion: With the increasing use of POCUS, critical care physicians should be aware of findings consistent with portal venous gas as a bedside tool for directing the treating physician toward an ominous diagnosis in patients with shock. Keywords: Point of care ultrasound, mesenteric vessel occlusion, portal vein gas. Recent Publications: 1. Bitar ZI, Shamsah M, Bamasood OM, Maadarani OS, Alfoudri H. Point-of-Care Ultrasound for COVID-19 Pneumonia Patients in the ICU. J Cardiovasc Imaging. 2021 Jan;29(1):60-68. doi: 10.4250/jcvi.2020.0138. PMID: 33511802; PMCID: PMC7847790. 2. Lung Ultrasound and Sonographic Subpleural Consolidation in COVID-19 Pneumonia Correlate with Disease Severity. Zouheir Ibrahim Bitar, Mohammed Shamsah , OssamaSajeh Maadarani ,Omar Mohammed Bamasood, Ali Zouheir Bitar, and Huda Alfoudri . Critical Care Research and Practice Volume 2021, Article ID 6695033, 6 pages https://doi.org/10.1155/2021/6695033 3. Maadarani O, Bitar Z, Zaalouk T, Mohsen M Elshabasy R. Point-of-care ultrasound can suggest COVID-19. EJCRIM 2020;7: doi:10.12890/2020_001915. 4. Zaalouk, TM, Bitar, ZI, Maadarani, OS, Elhabibi, ME. Carbamazepine-induced Stevens-Johnson syndrome in a patient with history of methotrexate-induced mast cell activation syndrome. Clin Case Rep. 2021; 9: 256– 259. https://doi.org/10.1002/ccr3.3509 5. Bitar, Z.I., Maadarani, O.S., Zaalouk, T.M. et al. The use of point-of-care ultrasound to guide clinical management in intraabdominal hypertension. J Ultrasound 24, 183–189 (2021). https://doi.org/10.1007/s40477-020-00546-8 6. Maadarani O, Bitar Z, Elshabasy R, et al. Double heart – chronic large missed pseudoaneurysm of left ventricle. JRSM Open. July 2021. doi:10.1177/20542704211025258 7. Bitar, Z. , Al-Ajmi, M. , Maadarani, O. , Shammari, Y. , Elzoueiry, M. and Al-Muwaizri, M. (2021) Attitude (Acceptance) of the COVID-19 Vaccine among Adult Kuwait Oil Company Workers. Open Journal of Internal Medicine, 11, 210-219. doi: 10.4236/ojim.2021.114017.
