Pneumatosis intestinalis and hepatic portal venous gas caused by mesenteric ischemia in an aged person.
An 82-year-old woman complaining of abdominal pain and vomiting was admitted to our emergency department. Abdominal X-ray, ultrasonography, and computed tomography showed hepatic portal venous gas, as well as pneumatosis intestinalis. We first suspected superior mesenteric arterial thrombosis. However, her physical findings, including computed tomography scanning and laboratory data, did not support the presence of bowel necrosis. The gas disappeared after 1 day. After the 12th day, she had recovered with conservative therapy, and she was discharged on the 41st day. Many reports indicate that hepatic portal venous gas is often associated with bowel necrosis, and urgent operation is recommended in such instances. In this patient, total colonoscopy on the 7th day revealed longitudinal redness, suggesting mesenteric ischemia. Thus, we speculate that this is a rare case of mesenteric ischemia without bowel necrosis associated with both pneumatosis intestinalis and hepatic portal venous gas.
Ohtsubo
K
K
Department of Internal Medicine and Medical Oncology, Cancer Research Institute, Kanazawa University, Japan.
Okai
T
T
Yamaguchi
Y
Y
Watanabe
H
H
Motoo
Y
Y
Matsui
O
O
Sawabu
N
N
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007511:Ischemia / Q000150:complications* / Q000628:therapy; D010288:Parenteral Nutrition / Q000379:methods; D011006:Pneumatosis Cystoides Intestinalis / Q000150:complications* / Q000628:therapy; D011168:Portal System; D013152:Splanchnic Circulation; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator