Abstract
Case 1 was an 84-year-old woman who was admitted to our hospital because of sudden upper abdominal pain and nausea. An abdominal CT scan revealed advanced portal venous gas and ileus. Since the development of pain and metabolic acidosis appeared, we performed an emergency operation. As irregular necrosis from the ileum to the right hemi-colon was observed, we resected the necrotic intestine. There was no occlusion of the mesenteric artery. We diagnosed the patient as having non-occlusive mesenteric ischemia. She was discharged on postoperative day 39. Case 2 is a 79-year-old woman referred to our hospital following the sudden onset of upper abdominal pain and nausea with a diagnosis of post-operative ileus. An abdominal CT scan revealed advanced portal venous gas and pneumatosis intestinalis. As strong abdominal pain and metabolic acidosis were observed at the first hospital visit, we performed an emergency operation under the diagnosis of intestinal necrosis. Intraoperatively, only postoperative adhesion was observed, without any ischemic change in the intestine. An adhesiotomy was performed, and the patient was discharged on postoperative day 28. Interestingly, these two clinical findings appeared quite similar, but had a contrasting operative course.
