A Case of Non-occlusive Mesenteric Ischemia Presenting with Hepatic Portal Venous Gas in a 101-year-old Female

Abstract

A 101-year-old female with abdominal pain and nausea was taken to our hospital by ambulance. Computed tomography (CT) revealed a lot of gas in the portal and superior mesenteric veins. Abdominal pain improved along with the recovery from hypovolemia. However, the patient developed abdominal pain again with high fever, vomiting and anal bleeding 8 hours later. CT revealed ascites, thickening of the ileum wall and elevation of the mesenteric density. Mesenteric ischemia was suspected and an emergency laparotomy was performed. 40 cm of the ileum demonstrated an ischemic change, and approximately 60 cm of the ileum was resected. The operation was performed smoothly and was uneventful. Histopathological analysis showed an acute ischemic changes without thrombus, suggesting non-occlusive mesenteric ischemia. The patient was discharged on the 36th day after the operation.