Transient portal venous gas secondary to acute gastric dilatation.

A female patient in her 60s with a history of Parkinson's disease developed epigastric and retrosternal chest pain, with associated vomiting. On examination, she had a distended abdomen with no focal peritonism. A computed tomography (CT) pulmonary angiogram was organized, which demonstrated no evidence of pulmonary emboli, but an incidental finding of gas within the liver peripheries and gastric fundal wall. A plain film abdominal radiograph demonstrated a significantly distended stomach. Thus, acute gastric dilatation was diagnosed. A nasogastric tube was introduced and intravenous fluids were given promptly. An urgent CT scan of abdomen and pelvis with intravenous contrast demonstrated interval reduction with only minor residual gas evident within the left lobe of the liver and gastric fundal wall. We report the case of transient portal venous gas, secondary to acute gastric dilatation, most likely caused by a combination of opioid analgesia and gastric dysmotility from Parkinson's disease.