腹腔内遊離ガスと門脈ガス血症を生じた原因不明の急性腹症の１例

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  • A CASE OF PNEUMOPERITONEUM ASSOCIATED WITH INTRA-ABDOMINAL FREE AIR AND HEPATOPORTAL VENOUS GAS FROM UNKNOWN CAUSE

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We report an emergency case of pneumopeirtoneum associated with intraabdominal free air and hepato-portal venous gas from unknown cause.<br>A 76-year-old woman bedridden due to a sequela after cerebral infarction suddenly vomited serousbloody fluid at night and was transferred to the hospital on December 4, 2003. Her abdomen was markedly distended and hard. Chest and abdominal plain X-rays revealed intra-abdominal free air. Computed tomography showed not only pneumoperitoneum but also intra-hepatic gas images developing a tree-like view in the peripheral portion of the liver. Necrotic perforation of the gastrointestinal tract was suspected, then exprolatory laparotomy was immediately done. An intensive intra-abdominal inspection could detect neither organ rupture nor ischemic changes in the gastrointestinal tract. There were no abnormalities in the genital system and diaphragm. No causes could be identified. Postoperative examination of the digestive system using contrast media or endoscope also revealed no organic abnormality related to the present unusual findings. It is etiologically thought that, since the patient had had remarkable aerophagia, the intraluminal pressure of the small intestine abruptly increased with the increase in intra-bowel gas when she vomited, causing disruption of the mucosal barrier and microperforation.

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