A Case of Descending Colon Perforation with Hepatic Portal Venous Gas

Kazuo Tsuno, Masanobu Maruyama, Tatsuo Yamazaki, Nobuji Ogawa and Toshitaka Furukawa

Department of Surgery, Maruyama Memorial General Hospital

A 85-year-old woman was admitted to our hospital because of gradually increasing abdominal pain after receiving a glycerin enema from her referring physician. Clinical deterioration, despite conservative therapy, manifested as a peritoneal irritation. An abdominal CT scan demonstrated hepatic portal venous gas, intraabdominal free air, ascites, and gas in the mesenterium of the descending colon. An emergency laparotomy was perfomed under a diagnosis of a perforated descending colon. Hartmann's procedure was performed, The postoperative course was uneventful except for blood coagulation abnormalities and a wound abscess. This case presents an interesting diagnosis of colon perforation. The CT findings were valuable in detecting the flow of gas from the etiologic location to the hepatic portal vein.

Key words
hepatic portal venous gas, colon perforation, ischemic colitis

Reprint requests
Kazuo Tsuno Department of Surgery, Maruyama Memorial General Hospital 2-10-5 Honcho, Iwatsuki City, 339-8521 JAPAN

Accepted
October 31, 2001

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