Pneumomediastinum, stomach wall and hepatic portal vein gas secondary to partial necrosis of the stomach wall.

The combination of pneumomediastinum, gastric wall gas and hepatic portal vein gas is a challenging clinical problem. Although different causes of the individual gas sign have been reported in the literature, the cause of a triad of these signs in a single patient is less clear, and represents an extremely rare condition. A 65-year-old man presented with severe lower chest and epigastric pain of a few hours' duration. Initial assessment confirmed epigastric tenderness. Computed tomography showed pneumomediastinum, air in the stomach wall, hepatic portal vein gas and bowel dilatation. Small bowel and right colon dilatation was confirmed at laparotomy. The patient was treated subsequently with antibiotics to cover Gram-positive and Gram-negative bacteria, and anaerobes. The patient was discharged in good general condition on the 12th postoperative day. In conclusion, the triad of pneumomediastinum, gastric wall gas and hepatic portal vein gas is an extremely rare condition and associated with gastric necrosis.