A 66-year-old Japanese woman, with a history of suspected paralytic ileus, had suffered from abdominal distension and frequent diarrhea since 2016. She visited our hospital for the additional symptom of dysphagia, and she was admitted with suspected paralytic ileus. Although her abdominal computed tomography scan showed marked dilatation of the intestinal tract and air-fluid levels, no stenosis or obstruction was found. Her blood test showed a decreased serum albumin level. Detailed examinations for the differential diagnosis of a disease characterized both by paralytic ileus and by diarrhea were carried out, but no markedly abnormal findings were revealed by blood tests, endoscopic examination, and imaging studies. Thus, a chronic infection or a systemic disease was unlikely. However, on the basis of the diagnostic criteria, she was suspected of having chronic idiopathic pseudo-obstruction. Her symptoms were markedly improved by the administration of a poorly absorbable antibiotic and prokinetics.
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.