A Case of Conservative Treatment of Hepatic Portal Venous Gas Detected After Gastrectomy

Abstract

An 81-year-old male patient was referred to our hospital for examination of anemia. Based on the findings of esophagogastroduodenoscopy and computed tomography, the patient was diagnosed as having advanced gastric cancer (cT3N0M0, cStage Ⅱ). Proximal gastrectomy was performed, and a jejunostomy was created. During the postoperative period, the patient showed an exaggerated inflammatory reaction. On the 6^th day after surgery, the serum CRP was 30.9 mg/dL, although there were no abdominal signs or fever. Abdominal CT showed hepatic portal venous gas. As no sign of intestinal necrosis was detected, the patient was observed carefully, without proactive treatment. The hepatic portal venous gas disappeared spontaneously within a few days, and the patient was discharged on the 26th day after surgery. Hepatic portal venous gas was once considered as a sign of intestinal necrosis, and therefore, was a definitive indication for surgery. However, recently, there have been several reports of patients with hepatic portal venous gas who were treated conservatively. Herein, we report the case of a patient who showed appearance of hepatic portal venous gas after gastrectomy and was successfully treated without surgery.