Pneumatosis intestinalis and hepatic portal venous gas caused by enteral feeding after a heart valve surgery


      An 81-year-old female with a history of type I diabetes mellitus underwent mitral valve repair and tricuspid annuloplasty for severe mitral and tricuspid regurgitation. A nasogastric tube was inserted on postoperative day 2, and enteral feeding was initiated. She complained about severe abdominal pain on postoperative day 7. Contrast-enhanced computed tomography revealed a massive hepatic portal venous gas and pneumatosis intestinalis of the small intestine. Emergency laparotomy showed no evidence of transmural necrosis. Bowel resection was not performed. On the next day, computed tomography showed an almost complete resolution of the portal venous gas and pneumatosis intestinalis. She was discharged home.

      Learning objective

      Cardiac surgeons should still be aware that enteral feeding is a potential risk factor for pneumatosis intestinalis and hepatic portal venous gas as a sign of non-occlusive mesenteric ischemia due to impaired blood supply, intestinal distension, and toxic mucosal injury.


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