A Case of Mucosal Necrosis with Massive Portal and Superior Mesenteric Venous Gas: Propriety and Risk of Preservation of the Intestine with Mucosal Necrosis

Yoshihiro Moriwaki, Kenichi Yoshida, Shigeru Yamagishi, Satoshi Hasegawa, Takayuki Kosuge, Toshiro Yamamoto and Mitsugi Sugiyama

Critical Care and Emergency Center, Yokohama City University Medical Center

We reported a rare case involving portal and superior mesenteric venous gas. A 81-year-old man with peritonitis underwent emergency surgery for portal, superior mesenteric, and peripheral mesenteric venous gas detected by computed tomography and ultrasonography. Most of the jejunum and ileum and their mesenteric portions showed postischemic change, and 10 cm of the involved ileum showed transmural necrosis without perforation. Only the transmurally necrotic part of the ileum was resected. Mucosa of the remnant small bowel was black but peristalsis, wall tension, and mesenteric pulsation of the remnant small bowel were maintained, indicating ischemic change was reversible and nonocclusive due to a transient decrease in systemic blood pressure. We surmised a chance existed for the remnant ischemic small bowel to recover by maintaining systemic circulation, and conducted intestinal anastomosis. Although the patient suffered from postoperative pneumonia, he was transferred to another hospital without progression of ischemic changes in the remnant small bowel.

Key words
portal venous gas, nonoclusive mesenteric ischemia (NOMI), salvage of intestinal mucosal, necrosis

Reprint requests
Yoshihiro Moriwaki Critical Care and Emergency Center, Yokohama City University Medical Center 4-57, Urefune-cho, Minami-ku, Yokohama, 232-0024 JAPAN

Accepted
January 22, 2003

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