Two Cases of Hepatic Portal Venous Gas due to Strongyloidasis

Tsuyoshi Teruya, Masamori Shimabuku^*, Tomonori Furugen, Kazuo Taira, Hiroshi Miyazato, Manabu Kudaka, Kazuya Yamashiro and Mitsuo Yogi

Department of Surgery, Naha City Hospital
^*Department of Surgery, Nothern Medical Center

Hepatic portal venous gas (HPVG) is a rare condition with a poor prognosis whose pathogenesis is not clearly understood. We present 2 cases of HPVG apparently associated with strongyloidiasis. Case 1, a 61-year-old man admitted with appetite loss due to chemotherapy for adult T cell leukemia, suffered abdominal pain after admission. He had a history of HTLV-1 infection and strongyloides infection was found by stool culture. He suddenly went in septic shock on day 4 after admission and abdominal computed tomography (CT) showed peripheral air distribution in the hepatic portal vein and dilation of the small intestine, which we diagnosed as HPVG and ileus. Intensive chemotherapy included thiabendazole was started and he recovered without surgery. Case 2, an 82-year-old woman admitted for abdominal pain was shown by abdominal CT to have intestinal dilation and HPVG. As conservative therapy was not effective, we conducted an emergency laparotomy about 3 days after the onset under a strong suspision of bowel necrosis with HPVG. The ileum end was necrotized and 80 cm of the ileum segment was resected. Postoperative stool culture showed positive strongyloides infection. Postoperative intensive therapy included thiabendazole, with good results. HPVG associated with strongyloides has not been reported, to our knowledge, and our cases were successfully treated by conservative and surgical measures.

Key words
hepatic portal venous gas, strongyloidiasis, sepsis

Reprint requests
Tsuyoshi Teruya Department of Suregery, Naha City Hospital
2-31-1 Furujima, Naha City, 884-5111 JAPAN

Accepted
March 27, 2002

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