A Case of Hepatic Portal Venous Gas caused by Clostridium Perfringens Infection in the Mucosal Layer of Ischemic Ileitis

Shoichi Fumoto¹⁾²⁾, Tsuyoshi Noguchi²⁾, Yuichi Akashi²⁾, Ryuichi Kikuchi²⁾, Katsunobu Kawahara²⁾ and Yuzo Uchida¹⁾

Department of Surgery, Shin-beppu Hospital¹⁾
Department of SurgeryII, Oita University, Faculty of Medicine²⁾

A 72-year-old man with abdominal pain and vomiting admitted in an emergency was found in abdominal computed tomography to have gas in the left hepatic portal vein and a thickened small intestinal wall. In immediate surgery under a diagnosis of hepatic portal venous gas due to necrotic bowel, we resected the necrotic ileum 15 cm to 75 cm from the Bauhin valve and conducted end-to end anastomosis.The resected necrotic intestine showed the presence of many bubbles of submucosal gas. Microscopic findings showed mucosal necrosis and Clostridium perfringens infection in the mucosal layer. Hyperbaric oxygenation therapy for two days after surgery resulted in an uneventful postoperative course, with the man discharged on postoperative day 17.

Key words
Clostridium perfringens infection, hepatic portal venous gas, ischemic ileitis

Reprint requests
Shoichi Fumoto Department of SurgeryII, Oita University, Faculty of Medicine
1-1 Idaigaoka, Hasama-machi, Oita-gun, 879-5593 JAPAN

Accepted
July 27, 2005

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