門脈ガス血症と腸管嚢腫様気腫症を呈した壊死性腸炎の1例

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  • A case of necrotizing geterocolitis with hepatic portal venous gas and pneumatosis cystoides intestinalis.

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A 68-year-old man presented with abdominal pain and hematemesis after drinking alcohol excessively over many days. He was admitted with a diagnosis of peritonitis with shock and showed strong muscle guarding. Abdominal simple x-ray film and an abdominal computed tomography (CT) scan revealed dilation of the small intestine, gas in the intestinal wall, and dendric gas along with the intrahepatic portal vein. With a diagnosis of necrotizing enterocolitis with hepatic portal venous gas and pneumatosis cystoides intestinalis, a laparotomy was conducted and about 200cm necrotized intestine was resected. In the resected material, submucosal intramural gas was observed discontinuously in the necrotized part, but no organic, obstructive, or sclerotic change was seen in the mesenteric vessels.<br> We inferred that circulatory disturbance of mesenteric arteries caused the intestinal necrosis and gas infiltrated into the intestinal wall and portal veins. Hepatic portal venous gas is usually a sing of poor prognosis. Although there are some casse of hepatic portal venous gas in which conservative therapy is possible, it should be noted that mortality is still high.

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