保存的治療にて軽快した腸管気腫症を伴う門脈ガス血症の1例

  • 越川 克己
    名古屋大学大学院医学系研究科病態制御外科学
  • 杉本 博行
    名古屋大学大学院医学系研究科病態制御外科学
  • 金子 哲也
    名古屋大学大学院医学系研究科病態制御外科学
  • 竹田 伸
    名古屋大学大学院医学系研究科病態制御外科学
  • 井上 総一郎
    名古屋大学大学院医学系研究科病態制御外科学
  • 中尾 昭公
    名古屋大学大学院医学系研究科病態制御外科学

書誌事項

タイトル別名
  • A Patient with Hepatic Portal Venous Gas Accompanying Pneumatosis Cystoides Intestinalis Who Survived with Conservative Treatment

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We report a case in which a patient with hepatic portal venous gas accompanying pneumatosis cystoides intestinalis survived with conservative treatment. A 75-year-old woman reporting abdominal pain and vomiting and admitted was found in biochemical examination of the blood to have no increase in hepatic or biliary enzymes but an increase in WBC count and serum CRP. Computed tomography showed hepatic portal gas in the left and caudate lobes of the liver and pneumatosis cystoides intestinalis in the wall of the ascending colon. A nasogastric tube was placed to collect gastric content, with NPO under IVH control. During preparation for emergency surgery, the patient's abdominal pain decreased rapidly, her abdomen became flat and soft, and neither tenderness nor muscular defense was noted. Seven days later, computed tomography showed that both hepatic portal gas and the pneumatosis cystoides intestinalis had disappeared. The prognosis of disease complicated by portal venous gas is usually poor, and an emergency surgery is often necessary. Several cases of hepatic portal venous gas treated successfully with conservative therapy have been reported recently. We review the literature concerning such therapy and discuss factors important to conservative therapy for he- patic portal gas.

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