Two Cases of Intestinal Ischemia Associated with Hepatic Portal Venous Gas

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Hepatic portal venous gas is a rare but important radiographic finding that is frequently associated with intestinal ischemia and high mortality. Here we report two cases. Case 1 was an 84–year–old man with respiratory failure and hypotension. Enhanced abdominal computed tomography (CT) revealed intraperitoneal effusion and gas in the branches of the portal vein in the peripheries of the liver. An emergent laparotomy was performed. A long section of the small intestine was necrotic, and 270 cm was resected. Pathological findings revealed ischemic enteritis. The patient died the day following surgery. Case 2 was a 78–year–old man who had hematemesis and melena. Enhanced abdominal CT revealed intraperitoneal effusion, intramural bowel gas, and intrahepatic portal venous gas. A long section of the small intestine and large intestine was discontinuously necrotic and about 300cm was resected. The patient died from acute myocardial infarction on the 12th day after surgery. Hepatic portal venous gas, particularly when associated with pneumatosis intestinalis, is an important finding suggestive of bowel ischemia. Clinicians must carefully distinguish ischemic from non–ischemic cases.
日本外科系連合学会の論文