{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:57:20Z","timestamp":1781672240187,"version":"3.54.5"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute aortic dissection (AAD) complicated by visceral malperfusion represents a catastrophic vascular emergency associated with high mortality. The coexistence of hepatic portal venous gas (HPVG) in this setting is an ominous radiological sign, typically indicating irreversible transmural bowel necrosis and breach of the mucosal barrier. We report a fatal case of STS\/SVS Type B3 aortic dissection presenting with extensive visceral ischemia and HPVG to highlight the diagnostic significance of this \u201cdeadly triad.\u201d<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 64-year-old male with a history of hypertension presented to the emergency department with severe, unremitting abdominal pain of 8\u202fh\u2019 duration. Physical examination revealed significant four-limb blood pressure asymmetry, with a systolic gradient of nearly 100\u202fmmHg between the right and left upper limbs, alongside diffuse abdominal tenderness. Computed tomography angiography (CTA) demonstrated an STS\/SVS Type B3 aortic dissection extending from the aortic arch to the iliac arteries. Critical findings included the celiac trunk and superior mesenteric artery (SMA) straddled the dissection flap, representing a typical combination of static and dynamic obstruction. Critical findings included diffuse HPVG, pneumatosis intestinalis, and multi-organ ischemia. Laboratory results showed admission leukocytosis (WBC 27.1\u202f\u00d7\u202f10\n                      <jats:sup>9<\/jats:sup>\n                      \/L) and a massive cytokine storm (IL-6: 14,001.98\u202fpg.\/mL) with refractory lactic acidosis. Due to the grave prognosis, the family opted for palliative care, and the patient expired 47\u202fh after the decision.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case underscores the rapid clinical deterioration associated with STS\/SVS Type B3 dissection and complex visceral malperfusion. Early CTA recognition of HPVG is vital for identifying irreversible intestinal damage and informing multidisciplinary decision-making in devastating vascular emergencies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1836688","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:49:06Z","timestamp":1781671746000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Catastrophic STS\/SVS type B3 aortic dissection complicated by hepatic portal venous gas and multi-organ malperfusion: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Jia","family":"Li","sequence":"first","affiliation":[{"name":"Department of Hepatobiliary Surgery 2, Meizhou People\u2019s Hospital, Meizhou Academy of Medical Sciences","place":["Meizhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinping","family":"Lan","sequence":"additional","affiliation":[{"name":"Cardiac Intensive Care Unit, Meizhou People\u2019s Hospital, Meizhou Academy of Medical Sciences","place":["Meizhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianbo","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Imaging, Meizhou People\u2019s Hospital, Meizhou Academy of Medical Sciences","place":["Meizhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zifang","family":"Shang","sequence":"additional","affiliation":[{"name":"Research Experiment Center, Meizhou People\u2019s Hospital, Meizhou Academy of Medical Sciences","place":["Meizhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1001\/jama.2016.10026","article-title":"Acute aortic dissection and intramural hematoma: a systematic review","volume":"316","author":"Mussa","year":"2016","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e223","DOI":"10.1161\/CIR.0000000000001106","article-title":"2022 ACC\/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association\/American College of Cardiology Joint Committee on clinical practice guidelines","volume":"80","author":"Isselbacher","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1016\/j.jtcvs.2019.09.065","article-title":"Management of Acute Type B Aortic Dissection with Malperfusion via endovascular fenestration\/stenting","volume":"160","author":"Norton","year":"2020","journal-title":"J Thorac Cardiovasc Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/j.jvs.2019.11.013","article-title":"Society for Vascular Surgery (Svs) and Society of Thoracic Surgeons (Sts) reporting standards for type B aortic dissections","volume":"71","author":"Lombardi","year":"2020","journal-title":"J Vasc Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e36378","DOI":"10.1016\/j.heliyon.2024.e36378","article-title":"Hepatic portal venous gas after ingesting glyphosate: a case report and literature review","volume":"10","author":"Wu","year":"2024","journal-title":"Heliyon"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"525","DOI":"10.3892\/etm.2022.11452","article-title":"Clinical features and management of 20 patients with hepatic portal venous gas","volume":"24","author":"Zhang","year":"2022","journal-title":"Exp Ther Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"3585","DOI":"10.3748\/wjg.15.3585","article-title":"Hepatic portal venous gas: physiopathology, etiology, prognosis and treatment","volume":"15","author":"Abboud","year":"2009","journal-title":"World J Gastroenterol: WJG"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s13017-022-00443-x","article-title":"Acute mesenteric ischemia: updated guidelines of the world Society of Emergency Surgery","volume":"17","author":"Bala","year":"2022","journal-title":"World J Emerg Surg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1186\/s12893-020-00973-8","article-title":"Clinical features of patients with hepatic portal venous gas","volume":"20","author":"Fujii","year":"2020","journal-title":"BMC Surg"},{"key":"ref10","first-page":"372","article-title":"Hepatic portal venous gas complication associated with the thoracic endovascular aortic repair for aortic dissection: a case report and literature review","volume":"13","author":"Duan","year":"2023","journal-title":"Am J Cardiovasc Dis"},{"key":"ref11","volume-title":"Visceral Malperfusion in Aortic Dissection: The Michigan Experience. Seminars in thoracic and Cardiovascular Surgery","author":"Kamman","year":"2017"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"167","DOI":"10.3390\/jpm14020167","article-title":"The challenge of Pneumatosis intestinalis: a contemporary systematic review","volume":"14","author":"Perrone","year":"2024","journal-title":"J Personalized Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"596","DOI":"10.21470\/1678-9741-2018-0287","article-title":"Profiles and predictive values of Interleukin-6 in aortic dissection: a review","volume":"34","author":"Yuan","year":"2019","journal-title":"Braz J Cardiovasc Surg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1038\/ajg.2017.38","article-title":"Predictive factors of intestinal necrosis in acute mesenteric ischemia: prospective study from an intestinal stroke center","volume":"112","author":"Nuzzo","year":"2017","journal-title":"Off J Am Coll Gastroenterol ACG"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1836688\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:49:30Z","timestamp":1781671770000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1836688\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,17]]},"references-count":14,"alternative-id":["10.3389\/fmed.2026.1836688"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1836688","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,17]]},"article-number":"1836688"}}