2018 Volume 46 Issue 1 Pages 17-23
A 64-year-old man was diagnosed as having alcoholic cirrhosis 21 years ago. Abdominal pain appeared one week before his first visit to a clinic, and exacerbation of his abdominal pain, diarrhea, and vomiting occurred on the same day, so he was urgently transported to our hospital. Upon physical examination, tenderness on pressure and spontaneous pain centered on the left abdomen were observed, and symptoms of peritoneal irritation such as muscular guarding and rebound pain were present across the entire abdomen. Abdominal contrast computed tomography revealed a thrombus from the portal vein to the superior mesenteric vein, and because edematous changes in the mesentery were observed by partial contrast effect in the ileum, we suspected superior mesenteric vein thrombosis and intestinal ischemia and performed emergency surgery. We partially resected the small intestine because about a 40-cm length of the intestine at 80 cm from the end of the ileum had turned dark red in color. Histopathologically, hemorrhage in all layers, mucosal necrosis, and edematous change in the submucosa were observed, which we diagnosed as small intestine necrosis. The patient’s postoperative course was good. He started eating from postoperative day 5 and was discharged from the hospital on postoperative day 21. There has been no recurrence at 3 months after surgery.
