門脈ガス血症の３例

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  • THREE CASES OF HEPATIC PORTAL VENOUS GAS

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Three cases of hepatic portal venous gas (PVG) are reported.<br> Case 1: A 75-year-old woman who had been treated for abdominal pain elsewhere was referred to the hospital because of intensifying ileus symptoms. Abdominal CT scan revealed PVC and remarkable intestinal gas image. Hematological studies showed increases in CRP of 36.81mg/dl and CPK of 1457IU/L. Acute mesenteric artery occlusion was suspected and an emergency operation was carried out. At surgery intestinal necrosis from 130cm distal from the ileum end to 10cm from the ascending colon was identified, and removal of the necrotic intestine and small intestinal fistula were made. After the operation the patient required ICU management, but she was transferred to another hospital very much improved on the 125th postoperative day.<br> Case 2: A 66-year-old man was referred to the hospital because of vomiting and abdominal pain. Abdominal CT scan revealed PVG, but CRP was 5.23mg/dl, and there were no muscle guarding and rebound tenderness, so that conservative therapy was conducted. After admission, the patient passed massive stools when the symptoms disappeared. The patient was discharged from the hospital on the 20th hospital day.<br> Case 3: A 66-year-old man was seen at the hospital because of abrupt onset of serious abdominal pain and vomiting. Abdominal CT scan revealed PVG, but CRP was 5.34mg/dl and there were no muscle guarding and rebound tenderness, so that conservative therapy was conducted. Since the patient had been receiving an α-glucosidases inhibitor orally for DM, PVG might be induced by an increase in the internal pressure of the intestine due to the drug.

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