A Case of Preoperative Diagnosis of Mesenteric Artery Thrombosis Revealed Gas in the Mesenteric Vesseles

Abstract

A 73-year-old man brought to our hospital with to severe abdominal pain and vomiting of sudden onset had a history of apoplexy, arrhythmia, and surgery for lung cancer. The next day, he was referred to our department with progressive abdominal pain and muscular defense. He was in agony with slight bulging, severe tenderness, and spontaneous pain and muscular defense in the abdomen. Abdominal Xray film taken laterally revealed dilation of the small intestine and niveau. Computed tomography (CT) of the abdomen revealed gas in the mesenteric vessels but not in the hepatic portal vein. Nevertheless, we suspected hepatic portal venous gas and operated immediately. He had purulent ascites and necrosis of the duodenum on the oral side and jejunum on the anal side, so we resected the necrotic intestine and instituted drainage. CT thus proved useful in preoperative diagnosis of bowel necrosis.