Abstract
An 84-year-old man who had been in a nursing home because of hypertension, cerebral infarction and cognitive disorder was admitted to our hospital for nausea and bloody stool. He had a fever and tachycardia. Blood examination revealed elevated inflammatory reaction, and computed tomography (CT) showed hepatic portal vein gas, increased wall thickness of the colon and small intestine, and ascites. Although intestinal necrosis was suspected, conservative therapy was initiated, because of his advanced age and multiple comorbidities. His general condition gradually improved, and he began eating food on the 9th day and was transferred to a nursing home on the 55th day. Comparing the findings of a three-dimension angiography reconstructed by multi-detector row computed tomography from 13 hours after the onset of symptoms with that on the 8th day, it is believed that the patient suffered non-occlusive mesenteric ischemia (NOMI) on arrival, and recovered without laparotomy. There have been five case reports of NOMI with hepatic portal gas improved by conservative therapy in the Japanese literature. Both NOMI and portal gas are thought to be an index of critical illness, however, conservative therapy may be effective in selected patients whose general condition, abdominal findings, and image findings are improved by initial treatment.
