K. Ohtsubo et al., Pneumatosis intestinalis and hepatic portal venous gas caused by mesenteric ischemia in an aged person, J GASTRO, 36(5), 2001, pp. 338-340
An 82-year-old woman complaining of abdominal pain and vomiting was admitte
d to our emergency department. Abdominal X-ray, ultrasonography, and comput
ed tomography showed hepatic portal venous gas, as well as pneumatosis inte
stinalis. We first suspected superior mesenteric arterial thrombosis. Howev
er, her physical findings, including computed tomography scanning and labor
atory data, did not support the presence of bowel necrosis. The gas disappe
ared after 1 day. After the 12th day, she had recovered with conservative t
herapy, and she was discharged on the 41st day. Many reports indicate that
hepatic portal venous gas is often associated with bowel necrosis, and urge
nt operation is recommended in such instances. In this patient, total colon
oscopy on the 7th day revealed longitudinal redness, suggesting mesenteric
ischemia. Thus, we speculate that this is a rare case of mesenteric ischemi
a without bowel necrosis associated with both pneumatosis intestinalis and
hepatic portal venous gas.