Hepatic Portal Venous Gas in a Man on Maintenance Hemodialysis

A 66-year-old man who had been on maintenance hemodialysis for 8 consecutive years in our department presented with a 12-hour history of severe abdominal pain, emesis, and inability to pass flatus. His body temperature was 36.5°C (97.7°F), pulse was 105 beats per minute, blood pressure was 131/70 mm Hg, respiratory rate was 25 breaths per minute, and oxygen saturation was 93% on room air. On examination, diffuse abdominal distension, absent bowel sounds, and mild tenderness were detected. The most severe pain was in the right upper quadrant with the pain intensity at 8 of 10.