A case of pneumatosis cystoides intestinalis and hepatic portal venous gas caused by the necrotic ischemic enteritis with klebsiella pneumoniae infection

Abstract

In April 2009, a 66-year old man with loss of consciousness was admitted to emergency ; blood test results included evidence of a significant acidosis and hyperglycemia. After admission, he complained of left lower abdominal pain ; on CT, portal venous gas and pneumatosis cystoides intestinalis were noted. Emergency surgery was done under a diagnosis of hepatic portal venous gas due to intestinal necrosis ; the necrotic descending colon up to the rectosigmoid was resected. Microscopic findings included necrosis and emphysema in all layers of the intestine ; there were many Klebsiella pnuemoniae organisms in the necrotic intestine. Polymyxin B immobilized five column therapy was given after surgery. His postoperative course was uneventful. The patient was discharged on postoperative day 28.