Abstract
A 73-year-old woman with 3-day-long right lower abdominal pain and high fever was referred to our hospital under the diagnosis of ileus. Her abdomen was distended with tenderness throughout the abdomen. Computed tomography showed free air at subphrenic region and portal vein gas in the left lobes of the liver. It also revealed the distension and pneumatosis cystoides of the small intestine wall. An emergency operation was carried out under the diagnosis of peritonitis due to perforation of some part of bowel necrosis. Operative findings showed the small intestine was dilated but not necrotic. Following a precise examination of the ileocecal region, a perforated and necrotic appendix was discovered. An appendectomy and abdominal drainage were performed. According to the literature reports, cases of the hepatic portal venous gas due to perforated appendicitis are rare, with our case being the 7th case in Japan.
