ABSTRACT

Hepatic portal venous gas is a rare clinical picture with high mortality. It is characterized by the accumulation of gas in the portal system on radiological examination. We presented a 74-year-old male patient on follow-up for sigmoid diverticulitis, developed progressive colovenous fistula and hepatic portal venous gas, ended with death. Diverticulitis is mainly associated with sigmoid diverticulosis. The anti-biotherapy is preferred if there is any contamination in the surrounding adipose tissue or an abscess formed adjacent to the colon wall. However, surgery is required if there is no regression in the follow-up. Colovenous fistula is rarely encountered in the etiology of hepatic portal venous gas but should be kept in mind. A quick diagnosis, the determination of its etiology and the choice of appropriate surgical treatment, and the post-operative interventions are expected to decrease the mortality rates associated with the disease.