Early Detection of Hepatic Portal Venous Gas Caused by Necrosis of the Ileum: A Case Report

Chihiro Sakamoto, Saiho Ko, Takashi Hachisuka, Fumikazu Koyama, Mitsuo Nagao, Hisanori Kashizuka, Ryo Yoriki and Yoshiyuki Nakajima

Department of Surgery, Nara Medical Univercsity

A 59-year-old man with a history of systemic malignant lymphoma was undergoing a second cycle of CHOP therapy for malignant lymphoma. He reported increasing abdominal pain 1 day before consultation. Plain abdominal CT before consultation showed a pin-point lucency in the hepatic margin and we suspected hepatic portal venous gas (HPVG). Because no other intraabdominal lesion was found in plain CT, CT with contrast enhancement was done, showing dendritic HPVG in the hepatic margin and thickening of the dilated ileal wall. Under a diagnosis of ilealnecrosis with HPVG, we conducted surgery resecting a necrotic ileum between 120 and 220 cm from Treizs' ligament. The post operative course was uneventful, and CT on day 7 showed disappearance of the HPVG. The prognosis of HPVG due to intestinal necrosis is poor. In this case, we detected early HPVG which helped make a quick decision to emergency surgery and an uneventful recovery.

Key words
hepatic portal venous gas, ileal necrosis, chemotherapy

Reprint requests
Chihiro Sakamoto Department of Surgery, Nara Medical University
840 Shijo-cho, Kashihara, 634-8522 JAPAN

Accepted
October 19, 2004

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