A Case of Nonocclusive Mesenteric Ischemia with Portal Venous Gas Diagnosed and Treated with Laparoscopy

Osamu Ikeda, Takashi Katsumori, Hiromitsu Hamaguchi, Hideyuki Tanaka, Nobutaka Sato, Hisami Ooshima and Hideo Baba*

Department of Surgery, Arao Municipal Hospital
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University*

A 76-year-old man admitted for sudden onset of epigastralgia, nausea, and vomiting was found in abdominal plain CT to have portal venous gas in the liver but no apparent findings of bowel necrosis. Although portal venous gas disappeared the next day, melena, wall thickness of the ileum, and ascites appeared. Based on these findings, we conducted emergency laparoscopy based on suspected mesenteric ischemia. Operative findings showed bloody ascites and an ischemic, edemoatous jejunum about 40 cm long. We resected the lesion and conducted anastomosis. Mesenteric artery pulsation of the lesion was preserved. Histological findings of the resected specimen showed hemorrhagic necrosis of the jejunum without thrombosis or angitis in the mesenteric vessels. Based on these findings, the definitive diagnosis was nonocclusive mesenteric ischemia. Several cases of portal venous gas treated conservatively have been reported recently, but we should regard portal venous gas as a severe condition with poor prognosis, and bowel necrosis should be kept in mind. If we suspect bowel necrosis, laparoscopy, which is less invasive, is useful both for diagnosis and treatment.

Key words
nonocclusive mesenteric ischemia, portal veinous gas, laparoscopic surgery

Reprint requests
Osamu Ikeda Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
1-1-1 Honjo, Kumamoto, 860-8556 JAPAN

Accepted
May 31, 2006

To read the PDF file you will need Abobe Reader installed on your computer.