Hepatic Portal Venous Gas and Pneumatosis Intestinalis Associated With Early Oral Feeding After Laparoscopic Total Gastrectomy

Early oral feeding (EOF), a key component of enhanced recovery after surgery (ERAS), has been proven to be safe and associated with a significant reduction in overall complications, but the safe volume for EOF remains ambiguous, and rare complications have been reported in recent years. We report a case of 68-year-old male, who underwent laparoscopic total gastrectomy, voluntarily consumed 1500 mL of enteral nutrition formula due to hunger on postoperative day 1. Within 3 hours, he developed fever, abdominal distension, palpitations, and nausea. Computed tomography (CT) revealed hepatic portal venous gas and pneumatosis intestinalis. Mechanical obstruction, anastomotic leakage, and necrosis were excluded, avoiding surgical intervention. Conservative management (intestinal decompression, antibiotics, and fluid resuscitation) led to a full recovery. Although rare, this case highlights potential risks of aggressive EOF regimens, emphasizing the need for individualized postoperative protocols, patient education, and vigilant monitoring to mitigate complications.