Abstract
We experienced treated 2 patients with extensive bowel necrosis showing hepatic portal venous gas (HPVG), one of whom died, but the remaining was saved from the fatal outcome. These cases and 45 cases in the Japanese literature re reviewed.
Case 1: A 35-year-old male with the primary complaint of abdominal pain transferred to the hospital. Emergency surgery showed thrombosis of the superior mesenteric artery, which was unresecta-ble and unreconstructable. He died on the first postoperative day.
Case 2: A 44-year-old female underwent emergency surgery with a diagnosis of panperitonitis. Extensive enterectomy was performed for thrombosis of the superior mesenteric artery, resulting in survival of the patient.
HPVG is known to be a condition with a poor prognosis, and impairments of the mucosal barrier, increased internal pressure of the digestive tract, and infection of the gas-producing microorganisms often follows to a serious clinical course including shock, and it should be understood as a sign of sepsis. Early diagnosis of bowel necrosis is important for improving the survival rate, and patients showing bowel necrosis cannot be saved by no treatments other than surgery, even if they are in shock.
