門脈ガス血症をきたしたｎｏｎｏｃｃｌｕｓｉｖｅ　ｍｅｓｅｎｔｅｒｉｃ　ｉｓｃｈｅｍｉａの１例

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  • A CASE OF NONOCCLUSIVE MESENTERIC ISCHEMIA CAUSING HEPATIC PORTAL VENOUS GAS

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An 82-year-old man was seen at the hospital because of abrupt onset of lower abdominal pain. There were previous histories of diabetes mellitus, hypertension, choronic heart failure, cerebral infarction, and bronchial asthma. When he was first seen, there was prominent spontaneous pain in the entire abdomen, but no muscle guarding and rebound tenderness were noted. Abdominal CT scan visualized the root of superior mesenteric artery; intrahepatic portal gas was shown in the bilateral lobes of the liver. The patient was operated on with a diagnosis of hepatic portal venous gas caused by ischemic intestinal disease. During surgery pulsations were palpable at the root of the upper mesenteric artery, but there were dilatation, edema, and mesenteric edema in the small intestine staring at a portion about 210cm distal from the Treitz' ligament, and a portion from the cecum to ascending colon. These lesions were removed and functional end-to-end anastomosis was performed. The patient gradually recovered after the operation and was discharged from the hospital on the 111th day after the operation. On pathological studies, hemorrhagic necrosis was seen in the intestinal mocosa but there were no abnormal findings such as thrombus in the mesenteric artery and vein, so that nonocclusive mesenteric ischemia was diagnosed.<br>Although the disease has a poor prognosis, simultaneous surgery can be expected when laparotomy is decided in an early time after the onset of the disease.

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