A Survived Case of Acute Mesenteric Arterial Occlusion with Gas in the Portal Vein in the Liver

Yoshiyuki Kuwabara, Makoto Kataoka, Atsushi Sato, Yasuyuki Kureyama, Hiroyuki Kawamura, Masami Mitani, Hiroshi Iwata, Mitsushi Sakagami, Taketoshi Kashima, Noriyuki Sinoda, Kohji Hattori, Takeshi Kamiya*, Akira Masaoka

Second Department of Surgery and Third Department of Internal Medicine*, Nagoya City University Medical School

A 54-year-old man who had a past history of heart disease and cerebral infarction, suddenly experienced severe abdominal pain. Abdominal ultrasonography and computed tomography revealed hepatic portal venous gas, and abdominal angiography revealed acute mesenteric arterial occlusion. An abdominal operation revealed extensive intestinal necrosis, from 60 cm to 80 cm below the Treitz's ligament and from 145 cm below the Treitz's ligament to ascending colon, and many gas bubbles in the marginal veins of the mesentery. Each necrosed intestine was resected and end-to-end anastomosis was made respectively. The length of the survived small intestine was only 120 cm. In the resected specimen, many submucosal gas bubbles (1 mm) were observed in the necrotic intestine, and this state was considered to be pneumatoiss intestinalis. Postoperatively the patient did relatively well, and was discharged on the 35th day after surgery. Up to now, no patient surviving mesenteric vascular occlusion with hepatic venous gas has been reported in Japan, and only 2 cases have been reported world wide. Therefore our case is considered a very rare one.

Key words
superior mesenteric arterial occlution, portal venous gas in the liver

Reprint requests
Yoshiyuki Kuwabara The Second Department of Surgery, Nagoya City University Medical School
1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya City, 467 JAPAN

Accepted
July 6, 1992

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