Abstract
A 75-year-old man with abdominal pain, diarrhea, and melena was transferred to our hospital. Laboratory data showed nothing other than hyperglycemia due to diabetes mellitus. Computed tomography (CT) demonstrated hepatic portal vein gas (HPVG) with a poorly-enhanced, thickened wall of the ascending and transverse colon. Colonic necrosis was suspected, and the patient was admitted. CT done the next day showed disappearance of the HPVG, but increased edematous change of the colon wall with ascites. Therefore, emergency surgery was performed. At laparotomy, edematous change of the ascending colon and ascites were found. A right hemicolectomy was performed. The pathological diagnosis was ischemic colitis with pneumatosis. After an uneventful postoperative course, the patient was discharged 12 days after surgery. Two weeks after discharge, he returned with abdominal pain and diarrhea. CT showed HPVG and a poorly-enhanced, thickened wall of the transverse colon, with some parts of the wall showing thinning, and gas in the greater omentum. He was readmitted for suspected colonic perforation. He recovered with conservative treatment and was discharged 17 days later. The outcome of this case suggests that HPVG can be treated conservatively in some cases of intestinal ischemia.
