Abstract
The patient was a 71-year-old male who had a history of appendectomy and coronary artery bypass surgery. He visited the hospital mainly because of sudden abdominal pain. His body temperature was 36.5°C. Although he presented with tenderness in the periumbilical region, peritonitis signs were not observed. There were no abnormalities in the results of laboratory studies. Abdominal computed tomography showed branching gas extending to near the peripheral of the liver, a slightly dilated small intestine, and a dissecting aortic aneurysm in the superior mesenteric artery. Ischemic change in the intestine was not clearly observed. On the basis of these findings, the patient was diagnosed as having portal venous gas related to the dissecting aortic aneurysm. Accordingly, a conservative treatment consisting of starvation therapy and administration of broadspectrum antimicrobial agents was conducted. Four hours later, although there were no changes in the abdominal findings, we decided to carry out surgery because a small amount of melena and an inflammatory reaction in the laboratory tests were observed; thus; the possibility of intestinal necrosis could not be denied. A severe postappendectomy adhesion and a reddening and an edematous change in the ileum over 50 cm from the ileocecal junction to the oral side were observed; however, ischemic change was not observed upon laparotomy. Therefore, only adhesionolysis was performed. On the basis of the above findings, the cause of the portal venous gas seemed to be simple intestinal obstruction. The postoperative course was good and the patient was discharged from the hospital 10 days after the operation. Portal venous gas is often observed in cases associated with intestinal necrosis and is considered to be a condition with a poor prognosis. However, it has been reported that intestinal obstruction without ischemic change can cause portal venous gas such as that in our patient. Considering the high mortality rate associated with portal venous gas, it is important to consider ischemic change in the intestine or other conditions that cause ischemic change in the intestine, and to consider performing an early operation.
