A Saved Case of Nonocclusive Mesenteric Ischemia with Portal Venous Gas by Simultaneous Operation

Toshiyuki Kosuga, Nobuaki Fuji, Tsuyoshi Itoh, Taiji Watanabe, Kingo Kashimoto, Hiroki Taniguchi and Kazuyo Naito

Department of Surgery, Kyoto Prefectural Yosanoumi Hospital

An 83-year-old woman admitted following a transient ischemic attack showed right-quadrant abdominal pain and signs of peritoneal irritation and underwent abdominal computed tomography (CT). Gas was observed in the hepatic portal vein. The superior mesenteric artery root and duct were observed, but intestinal necrosis was suspected, necessitating emergency laparotomy. The pulse was palpable at the superior mesenteric artery duct, but partial necrosis was found in 20 cm of the intestine from the ascending to transverse colon, necessitating right hemicolectomy with simultaneous anastomosis. The postoperative course was good, gas in the portal vein disappeared within 48 hours postoperatively, and the patient was discharged on onset day 14. Histological findings showed hemorrhagic necrosis, but no thrombosis was observed in the mesenteric vessels and the patient was diagnosed with nonocclusive mesenteric ischemia. Few cases of this disease appear to have been reported in Japan and such patients generally exhibit a poor outcome. In this case, the patient was diagnosed early and underwent laparotomy without delay. Under careful consideration of the viability of the remaining intestines, the patient was treated with simultaneous operation with a successful outcome.

Key words
nonocclusive mesenteric ischemia, portal venous gas

Reprint requests
Toshiyuki Kosuga Department of Surgery, Kyoto Prefectural Yosanoumi Hospital
481 Otokoyama, Yosano-cho, Yosa-Gun, 629-2261 JAPAN

Accepted
May 31, 2007

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