Two Cases of Hepatic Portal Venous Gas without Bowel Necrosis

Yasushi Hashimoto, Yoshihiro Sakashita, Michio Takamura, Hiroshi Iwako, Yusuke Watadani*, Norifumi Shigemoto and Keishi Kin

Department of Surgery, Ohda Municipal Hospital
Department of Surgery, MAZDA Hospital*

Hepatic portal venous gas (HPVG) is considered as a poor prognostic condition requiring emergency laparotomy. Herein, we report two cases of HPVG without bowel necrosis. Case 1; A 78 year-old man was referred to our hospital because of abdominal pain. After the visit to the hospital, hematochezia was observed. Abdominal CT showed HPVG and massively edematous ileocecum. On emergency laparotomy, there was no necrotic bowel. Postoperative colonoscopy showed round, punched-out ulcers in the ileocecum, so we diagnosed this case as simple ulcers. Case 2; A 95 year-old woman admitted for sudden onset of abdominal pain was shown by CT to have massive amount of HPVG and remarkable dilatation of the ascending colon. Physical and laboratory examinations indicated not so severe conditions, so the patient was treated conservatively. In both cases, patients recovered uneventfully and HPVG disappeared on follow-through studies. However, HPVG does not always mean a bad sign if bowel necrosis is not associated and there are some cases of HPVG in which conservative therapy is possible, it is important to consider carefully the causes of HPVG for the best treatment.

Key words
hepatic portal venous gas, simple ulcer, conservative therapy

Reprint requests
Yasushi Hashimoto Department of Surgery, Ohda Municipal Hospital
1428-3 Yoshinaga, Ohda-cho, Ohda, 694-0063 JAPAN

Accepted
September 22, 2004

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