Is hepatic portal venous gas an indication for exploratory laparotomy?

Three patients with roentgenographic evidence of hepatic portal venous gas (HPVG) were hospitalized within a one-month period at one hospital. The abdominal roentgenograms were obtained because the clinical signs of abdominal rigidity, distention, or both were present. Each patient had exploratory laparotomy after the HPVG was seen. During the operations, extensive cyanotic/necrotic bowel was found. The patients died within a few hours after the procedures. These cases bring the total to 67 cases in the retrievable literature. One quarter of the patients described have survived; none of them had extensive bowel necrosis associated with their HPVG. In order to determine the extent of bowel necrosis associated with HPVG, and to determine if treatment is possible, an exploratory laparotomy should be performed.