腸管気腫症および門脈ガス血症治癒後低血糖を起こした1例

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A 78-year-old man who had malnutrition and Parkinson’s disease vomited. Abdominal X-ray showed a distended stomach,small intestine and colon.Abdominal computed tomography(CT)indicated ascites,hepatic portal venous gas (HPVG), thickened intestinal wall and pneumatosis cystoides intestinalis (PCI)in the wall of the small intestine. Because there was no sign of peritoneal irritation, we decided to use conservative therapy. Neither HPVG nor PCI was observed on the abdominal CT scan taken 14 days after the onset of failure.Oral intake was started and the patient took a 1400-kilocalorie diet daily.The levels of serum alanine aminotransferase (ALT),aspartate aminotransferase (AST)and lactate dehydrogenase (LDH)were increased on the 40th day after the onset of failure.On the 46th day,respiratory and cardiac arrest occurred.His blood sugar level was below 20mg/dl. Intravenous hyperalimentation was started. Hypoglycemia was not present from the next day. The cause of the hypoglycemia was supposed to be malabsorption and liver insufficiency, which might have been caused by HPVG and PCI. It is supposed that patients with HPVG and PCI with malnutrition need careful observation for a long period after recovery from HPVG and PCI. Shinshu Med J 59 : 265― 271, 2011