A Patient with Hepatic Portal Venous Gas Accompanying Pneumatosis Cystoides Intestinalis Who Survived with Conservative Treatment

Katsumi Koshikawa, Hiroyuki Sugimoto, Tetsuya Kaneko, Shin Takeda, Soichiro Inoue and Akimasa Nakao

Department of Surgery II, Nagoya University School of Medicine

We report a case in which a patient with hepatic portal venous gas accompanying pneumatosis cystoides intestinalis survived with conservative treatment. A 75-year-old woman reporting abdominal pain and vomiting and admitted was found in biochemical examination of the blood to have no increase in hepatic or biliary enzymes but an increase in WBC count and serum CRP. Computed tomography showed hepatic portal gas in the left and caudate lobes of the liver and pneumatosis cystoides intestinalis in the wall of the ascending colon. A nasogastric tube was placed to collect gastric content, with NPO under IVH control. During preparation for emergency surgery, the patient's abdominal pain decreased rapidly, her abdomen became flat and soft, and neither tenderness nor muscular defense was noted. Seven days later, computed tomography showed that both hepatic portal gas and the pneumatosis cystoides intestinalis had disappeared. The prognosis of disease complicated by portal venous gas is usually poor, and an emergency surgery is often necessary. Several cases of hepatic portal venous gas treated successfully with conservative therapy have been reported recently. We review the literature concerning such therapy and discuss factors important to conservative therapy for hepatic portal gas.

Key words
portal venous gas, pneumatosis cystoides intestinalis, conservative therapy

Reprint requests
Katsumi Koshikawa Department of Surgery II, Nagoya University School of Medicine
65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 JAPAN

Accepted
November 26, 2003

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