Abstract
A 78-year-old man with ampullary carcinoma had undergone pylorus-preserving pancreaticoduodenectomy. The histopathological findings included well-differentiated adenocarcinoma, pPanc2, pN0, pEM0, and Stage IVa. The patient received total enteral nutrition through a jejunostomy without oral intake over a long period of time postoperatively due to the formation of an intestinal fistula with wound infection. Although conservative therapy controlled his abdominal pain temporarily, the patient suffered severe pain and had strong inflammatory findings on Day 95 postoperatively. Abdominal CT examination showed massive accumulation of gas in the portal vein and the superior mesenteric vein. Emergency surgery was performed under the suspected diagnosis of of bowel ischemia. Segmental-scattered ischemic change, submucosal emphysema of the small intestine, and mesenteric emphysema were observed between the ileum at a distance of 15 cm from Bauhin′s valve and the jejunum near the duodeno-jejunostomy. The patient was finally diagnosed as having nonocclusive mesenteric infarction. He underwent massive resection of the small intestine, jejunostomy, and ileostomy. Although he initially recovered after the second operation, he died of a massive hemorrhage from the remnant small intestine 3 months after the operation.
