Abstract
Case 1 : A male in his 50s who had started hemodialysis for chronic renal failure with an unknown underlying disease in 1981 was taken off dialysis for renal transplantation in 1995. Hemodialysis had been reinitiated due to decreased function of the transplanted kidney in approximately August 2004. In August 2008, exertional dyspnea and epigastric pain were noted, and he was hospitalized for detailed examination. Computed tomography (CT) showed portal venous gas suggestive of intestinal ischemia. He died before surgical treatment could be performed. Case 2 : A male in his 70s had been started on peritoneal dialysis for chronic renal failure due to chronic glomerulonephritis in 1988, and was then switched to hemodialysis in 1992. In 2002, he underwent aortic valve replacement with a bioprosthetic valve. In 2008, he was hospitalized for exertional dyspnea and difficulty with fluid removal due to decreased blood pressure during hemodialysis. Severe aortic valve stenosis was noted, and acute exacerbation of cardiac failure due to worsening valvular disease was diagnosed. After hospitalization, administration of carvedilol was started. While the exertional dyspnea showed improvement, cardiac function did not. He experienced sudden abdominal pain during dialysis, and CT showed portal venous gas suggestive of intestinal ischemia. He underwent emergency surgery to remove the necrotic intestine but died 4 days later. Portal venous gas is a relatively rare condition. Hemodialysis for 20 years and significant left cardiac function failure were noted in both of our cases. We report these cases with discussion of the relevant literature.
