Abstract
We report a case of Portal Vein Gas (PVG) occurring after phlegmonous gastritis and duodenitis, with a background of Superior Mesenteric Artery Syndrome (SMAS). A 73-year-old man had been admitted for lower abdominal pain and diarrhea and treated for about two months. Upper abdominal distension and hemorrhagic vomiting suddenly appeared. The upper GI (Gastro-Intestinal) endoscopy revealed diffusely edematous and erosive changes with oozing hemorrhage in the gastric and duodenal mucosa. An abdominal CT scan examination showed remarkable swelling of the gastric wall. We diagnosed phlegmonous gastritis and duodenitis, and treated the patient with conservative therapy. With a complete relief of symptoms, the patient started meals. After the start of meals, abdominal pain and vomiting recurred. The abdominal CT scan showed gas in the superior mesenteric vein and dendritic gas in the portal vein which was spread to the liver edge. Dilatation of the stomach and duodenum and submucosal gas in the gastric and duodenal bulb were also detected. We diagnosed Portal Vein Gas (PVG) and decide to treat him conservatively. The patient was extraordinary emaciated (BMI 13.0) suggesting superior mesenteric artery syndrome (SMAS) as an underlying condition. We speculate that the meal intake caused the high pressure in the stomach and the duodenum by SMAS and PVG occurring through the mucosa damaged by phlegmonous gastritis and duodenitis. We should consider a possibility of SMAS in cases of the undernourished patients, especially with long confinement in bed.
