A Case of Non-fatal Jejunal Necrosis With Hepatic Portal Venous Gas

Hiroko Aruga, Terumasa Noike, Hide Kasai and Hideo Koike

Department of Surgery, Aizawa Hospital

A 74-year-old woman was admitted complaining of a sudden onset of abdominal pain and vomiting. Physical examination showed a soft bulging of the abdomen and mild abdominal tenderness. A plain abdominal radiograph showed dilated loops of the small intestine. Abdominal computed tomography revealed ascites and gas in the hepatic portal venous system, the wall of the small intestine and the mesenteric vein. A diagnosis of bowel necrosis with hepatic portal venous gas was determined, and a laparotomy was performed. A 40-cm length of jejunum was found to be necrotic and an enterectomy was performed. The patient made an uneventful recovery. Hepatic portal venous gas is a rare condition, caused mostly by ischemic enteropathy. It should be considered an indication of sepsis, since bacteria from the intestine may infect the portal venous system from an ulcer in the intestine. Generally, cases of hepatic portal venous gas follow a serious clinical course including shock. We reviewed 94 cases in the Japanese literature and found trend toward improving survival rate. The condition requires early diagnosis and surgical treatment.

Key words
sepsis, hepatic portal venous gas, bowel necrosis

Reprint requests
Hiroko Aruga Department of Surgery, Aizawa Hospital 3-1-1 Honjyou, Matsumoto, 390-8510 JAPAN

Accepted
November 30, 1999

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