Hepatic Infarction Associated with Terminal Hemorrhagic Necrotizing Enteropathy: A Case Report
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概要
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Circulation of both the liver and the mesentery is influenced through the portal vein, however, in both organs infarcts hardly occur because of their specific hemodynamics.The authors experienced an autopsy case of hepatic infarction associated with terminal hemorrhagic necrotizing enteropathy which had originated from nonocclusive infarcts of the jejunum in a 84-year-old woman.Autopsy: Four fresh coagulative necrotic foci, measuring 3-4cm in its diameter respectively, were located at the bilateral lobes of the liver. At the right truncus and left branch of the hepatic artery, thrombi were embolded. The thrombi seemed to be liberated from the mitral valve. In the other portion of the liver, marked centrolobular congestion was observed.The upper portion of the jejunum showed hemorrhage and necrosis. Cellular infiltration was not seen.Mesenteric arteries and veins were sclerotic, but no thrombi were found.The heart, weighing 500g, revealed left ventricular hypertrophy, and bilateral atria and ventricles were ectatic. The mitral valve showed fibrous endocarditis with calcification.Besides those, renal anemic infarct, fresh peptic ulcer of the stomach etc. were shown.From these observations, with the exception of the systemic circulatory failure based on the organic cardiac lesion, it is speculated that liver congestion from cardiac failure evoked hepatic infarction on one hand and intestinal infarct on the other hand.Both hepatic infarction and THNE in our case may have originated from the local circulatory failure through the portal vein.
- 社団法人 日本老年医学会の論文