非閉塞性腸管虚血症にともなった門脈ガス血症の1例

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  • A Case of Hepatic-Portal Venous Gas Associated with Non-Occlusive Mesenteric Ischemia

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A 60-year old man developed abdominal pain, vomiting and diarrhea after drinking alcohol, and brought to the nearest hospital with shock. He had consumed alcohol excessively for many years. Since fluid infusion administered for shock without influence, he transferred to our hospital on the next day. Abdominal CT revealed paralytic Hens, and gas in the hepatic-portal vein, the mesenteric vein, the splenic vein and the spleen. Urgent laparotomy was performed with a tentativediagnosis of bowel necrosis with hepatic-portal venous gas (HPVG). At laparotomy, an extensive necrotic change was seen from the stomach to the rectum, and the gall bladder. A diagnosis of non-occlusive mesenteric ischemia (NOMI) was determined in the pres-ence of patent superior mesenteric artery. He underwent no resection because the bowel gangrene was too extensive, and died soon after operation<BR>Including our case, there were 21 cases of HPVG associated with NOMI in the Japanese literature. Five patients died. Outcome was correlated with amount of the necrotic bowel. Although it is difficult to identify NOMI for patients with HPVG, there may be an association with dehydration and shock as well as a history of arteriosclerotic disease.

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