A rare case of hepatic portal venous gas (HPVG) diagnosed as emphysematous cystitis in an elderly diabetic dialysis patient

Hepatic portal venous gas (HPVG) is the presence of air bubbles in the portal vein and its branches. Traditionally it was considered a lethal condition because the main etiology was bowel ischemia. However, with the extensive use of diagnostic tools, it became clear that the causes of this condition are diverse and may include, but are not limited to, bowel necrosis. Here, we present a rare case of HPVG in an elderly dialysis patient with diabetes mellitus, initially diagnosed by ultrasound and CT scan. Our patient experienced abdominal pain, dysuria, oliguria, and other urinary symptoms starting three weeks prior. After considering all diagnostic tools and correlating them with the patient's history, clinical findings, and follow-up, the underlying cause of the HPVG was determined to be emphysematous cystitis. We concluded that the presence of HPVG in the initial screening test should prompt a comprehensive investigation to determine the cause, as a rare condition like emphysematous cystitis can result in HPVG.