A Survived Case of Acute Superior Mesenteric Artery Occlusion with Hepatic Portal Venous Gas

Toshimichi Sugawara, Nobuyuki Okada, Katsu Suzuki, Mari Kamei, Masao Sato, Hideo Goto*

Department of Surgery, and Department of Roentgenology*, Iwate Prefectural Miyako Hospital

The acute superior mesenteric artery occlusion associated with hepatic portal venous gas (HPVG) has a grave prognosis, and only three survivous have been reported in Japan. Here we report one more survival. A 71-year-old man, who had a past history of atrial fibrillation, suddenly complained of severe upper abdominal pain. Abdominal computed tomography revealed HPVG, and an emergency laparotomy was performed about 32 hours after the onset. The operation revealed extensive necrosis of the bowel from the jejunum to the transvers colon. All of the necrotic bowel was resected and end-to-end jejunocolostomy was performed. The length of the intact small intestine was only 24 cm. In the resected specimen, submucosal gas bubbles were observed, and this state was considered to be pneumatosis cystoides intestinalis. The postoperative course was uneventful. Because of the grave prognosis of bowel necrosis with HPVG, laparotomy should be performed as early as possible, if peritonitis with HPVG is suspected.

Key words
hepatic portal venous gas, superior mesenteric artery occlusion

Reprint requests
Toshimichi Sugawara Department of Surgery, Iwata Prefectural Miyako Hospital
1-11-26 Sakikumagasaki, Miyako, 027-0096 JAPAN

Accepted
January 14, 1998

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