title: Small intestinal Crohn's disease with hepatic portal venous gas: a case report.
abstract: An 80-year-old man presented in another hospital with acute abdominal pain; computed tomography indicated hepatic portal venous gas (HPVG) and small intestinal thickening. He was then transferred to our hospital, where we diagnosed idiopathic inflammation and stenosis of the ileum. Because the patient's abdominal symptoms were mild and his general condition was good, we chose to administer conservative therapy. His condition improved and we discharged him from our hospital. However, he was hospitalized again 9 days later because his abdominal pain had recurred and was worse. We performed a laparoscopic partial resection of the ileum 3 weeks after the patients' initial presentation. Macroscopically, longitudinal ulcers were observed near the stenosis of the ileum; the segment of the small intestine that contained the ulcers was removed, and subsequent pathological findings indicated Crohn's disease of the small intestine. The post-operative course was favorable, and the patient was discharged on post-operative day 9. Such serendipitous diagnosis of small intestinal Crohn's disease in an elderly patient with hepatic portal venous gas is rare; to our knowledge, this is the first of such case in which laparoscopic surgery was performed.
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan. masatoyamadera@yahoo.co.jp.
authors.forename: Masato
authors.initials: M
authors.lastname: Yamadera
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Kajiwara
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Shinto
authors.affiliation: Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Hokari
authors.affiliation: Department of Pathology and Laboratory Medicine, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Shimazaki
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hase
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ueno
keywords: Crohn’s disease; Hepatic portal venous gas; Laparoscopic surgery