A Case of Elective Surgery for Internal Hernia in the Paracolic Gutter of the Ascending Colon with Pneumatosis Intestinalis and Portal Vein Gas

Abstract

A 59-year-old man was admitted to our hospital with persistent abdominal pain and vomiting. The patient reported usual defecation the day before. The patient's vital signs were normal. Abdominal distention was detected but without peritoneal signs. Blood examination revealed renal dysfunction and a severe inflammatory reaction. An abdominal computed tomography (CT) scan revealed a small intestinal ileus, possibly caused by an obstruction in the upper right abdomen. Pneumatosis intestinalis and portal vein gas were also noted. However, there was no ascites. An intestinal tube was successfully inserted, and intravenous fluids therapy improved renal function and reduced inflammation. Despite defecation and flatus, abdominal distention persisted, and the patient underwent surgery. An internal hernia was observed in the paracolic gutter of the ascending colon. The partial obstruction was released. There was no necrosis, and bowel resection was not required. This is a rare case of an internal hernia with pneumatosis intestinalis and portal vein gas.