Abstract
Hepatic portal venous gas (HPVG) is a rare condition whose mortality rate is very high. We report a case of HPVG due to mesenteric panniculitis after exploratory laparotomy. The patient was an asymptomatic 76-year-old man, who was pointed out an elevated CA19-9 level (486.6U/ml) at a health checkup. A para-aortic mass (sized 8×3cm) was revealed by abdominal CT and MRI scan. The patient received exploratory laparotomy, because the origin of this tumor was unknown. As a result, pancreas cancer showing extrapancreatic growth with severe fibrosis was diagnosed. On the 7th hospital day the patient suddenly developed abdominal pain, high fever over 39°C, and sepsis and went into endotoxin shock. Abdominal contrast enhanced CT scan showed intra-hepatic portal and mesenteric venous gas. The wall of the transverse colon and its mesentery were thick and edematous. Preoperative diagnosis was HPVG due to ischemic change of the transverse colon resulting from invasion of pancreas cancer to the mesenteric vein. We performed transverse colectomy and ascending colostomy 8 hours after the onset of the disease. The patient's general condition was improved following the emergency operation.
The histopathological diagnosis was panniculitis of the mesentery and omentum. This is the first case of HPVG due to mesenteric panniculitis in Japan. HPVG with sepsis is a gravely ill condition, but not always lethal. Early detection of HPVG by CT scan and prompt treatment can improve the mortality of HPVG.
