Abstract
A 79-year-old man revealed hepatic portal venous gas on an abdominal CT scan performed for his complaint of epigastric pain. Since prominent bowel ischemic changes were absent, the patient was admitted to our hospital to observe the clinical course. On the next day, another abdominal CT scan revealed free air and gas-containing liver abscess, and abdominal symptoms persisted. These conditions were determined to require intraperitoneal close examinations, and exploratory laparoscopy was performed. No abnormal bowel findings were revealed, but redness and tonicity of the gallbladder were noted. We diagnosed the case as hepatic portal venous gas and gas-containing hepatic abscess accompanied by cholecystitis, and performed laparoscopic cholecystectomy. Since then his abdominal symptoms rapidly improved. The patient was discharged from our hospital on the 18th postoperative day. Bacteriological culture of the venous blood and bile yielded Clostridium perfringens that led to the final diagnosis.
Although hepatic portal venous gas has been reported to be a sign of poor prognosis, early definite diagnosis and active treatments might promise improvement of therapeutic outcomes. This paper deals with our case of cholecystitis associated with hepatic portal venous gas and gas-containing liver abscess successfully diagnosed by laparoscopy.
