A Case of Superior Mesenteric Artery Occlusion with Portal Venous Gas which Emerged in Short Time from the Onset and Rescued by Surgery

Junichi Saito, Naoyuki Kobayashi, Hirohito Seki¹⁾, Yoshito Ueyama²⁾, Toshiaki Ikeda³⁾, Tetsuya Nakamura, Kenji Iwata and Eiji Kurihara

Department of Surgery, Inagi Municipal Hospital
Department of Surgery, Keio University School of Medicine¹⁾
Department of Pathology²⁾ and Department of Radiology³⁾, Inagi Municipal Hospital

An 86-year-old woman seen for abdominal pain and taking aspirin daily for atrial fibrillation was found on physical examination to have muscular guarding, and erect abdominal X-ray showed a large amount of gas in the small intestine. Three hours after onset, computed tomography (CT) showed hepatic portal venous gas (PVG) with branching and a small amount of air in the small intestinal wall. Her general condition worsened, necessitating emergency surgery under a diagnosis of panperitonitis due to intestinal necrosis. Moderate amounts of bloody ascites and marked edema and necrosis of the small intestine and an ischemic gray portion were seen. Pathological findings showed hemorrhagic necrosis throughout the entire small intestine and necrosis with blood coagulation in the mucosal layer consistent with superior mesenteric artery (SMA) occlusion. The postoperative course was fair. This is, to our knowledge, the second report of SMA occlusion associated with PVG detected less than three hours after onset. Surgical treatment should thus be considered in SMA occlusion with PVG at an early stage once intestinal necrosis is suspected.

Key words
portal venous gas, superior mesenteric artery occlusion

Reprint requests
Junichi Saito Department of Surgery, Inagi Municipal Hospital
1171 Omaru, Inagi, 206-0801 JAPAN

Accepted
January 28, 2009

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