Abstract
A 66-year-old woman was referred to our hospital with abrupt onset of upper abdominal pain while performing aerobics at the gym. Abdominal computed tomography (CT) revealed a dendriform image of hepatic portal venous gas in the bilateral lobes of the liver. Conservative medical treatment was provided because the patient's symptoms remitted soon after examination. The portal venous gas image was found to have almost disappeared in the abdominal CT examination performed on day 2 after admission. On day 29, the patient complained of abdominal pain again, and imaging tests were performed. As these clearly indicated stenosis of the ileum, partial ileocecal resection was performed. The postoperative course was uneventful, and she was discharged on day 48. After five months, the patient presented upper abdominal pain twice after squash. Abdominal CT examination revealed superior mesenteric venous gas as previously indicated. The patient was in shock on admission. On emergency laparotomy, there was no intestinal ischemia or necrosis. Because imaging tests indicated stenosis of the ileum in the vicinity of the last anastomosis, we performed partial ileocecal resection on day 49. We present a rare case of NOMI with repeated stenosis of the ileum after initial improvement with conservative medical treatment.
