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

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  • 門脈ガス血症を呈した非閉塞性腸管虚血症の1救命例

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Abstract

A 79-year-old woman who had a past history of angina pectoris and followed under medication suddenly experienced severe abdominal pain. She was taken to her previous hospital where abnormal intrahepatic gas was detected with CT examination, and on the following day she was referred to our hospital under the diagnosis of acute abdomen with pneumobilia. In our hospital, CT revealed the hepatic portal venous gas, but it quickly disappeared the next day. The end of ileum was edematous and not enhanced by contrast CT. We therefore performed an emergency operation under the tentative diagnosis of bowel necrosis. There was purulent ascites in the peritoneal cavity with limited necrosis of the ileum from 10 cm to 50 cm oral from the ileocecal valve. We resected this necrotic bowel and performed an ileostomy. Eventually the patient improved with no trouble and was discharged on the 22nd day. Hepatic portal venous gas is a rare complication observed in a case of ileus and bowel necrosis and is associated with a poor prognosis. We report herein on a case of hepatic portal venous gas associated with non-occlusive mesenteric ischemia.

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