Transient hepatic portal venous gas following resuscitated cardiac arrest in a patient with aconitine poisoning

INTRODUCTION: Hepatic portal venous gas is an uncommon radiological finding and is generally associated with a poor prognosis. CASE SUMMARY: A 46-year-old male presented with severe aconite poisoning after ingesting self-prepared aconite wine for joint pain. He suffered a cardiac arrest requiring prolonged cardiopulmonary resuscitation, defibrillation, and vasopressor support. On day 3, he developed a high fever, abdominal distension, and septic shock. IMAGES: Contrast-enhanced computed tomography on day 4 revealed multiple branching gas shadows within the left hepatic lobe, diagnostic of portal venous gas, as well as small bowel wall oedema with reduced enhancement, indicating potential intestinal ischaemia and necrosis. DISCUSSION: Portal venous gas accumulation originated from non-occlusive mesenteric ischaemia triggered by aconitine-mediated cardiovascular collapse. CONCLUSION: This patient highlights that in the context of toxin-induced cardiac arrest, hepatic portal venous gas can be a reversible consequence of the underlying shock, emphasizing the importance of treating the primary insult.