A CASE OF GROSSLY NECROTIC BOWEL WITH HEPATIC-PORTAL VENOUS GAS

Accession number;05A0436653
Title;A CASE OF GROSSLY NECROTIC BOWEL WITH HEPATIC-PORTAL VENOUS GAS
Author;ISHII TOMOHIRO(Yokohama City Univ. Medical Center, JPN)   MORIWAKI YOSHIHIRO(Yokohama City Univ. Medical Center, JPN)   KOSUGE TAKAYUKI(Yokohama City Univ. Medical Center, JPN)   FUJITA SEIICHIRO(Yokohama City Univ. Medical Center, JPN)   TOYODA HIROSHI(Yokohama City Univ. Medical Center, JPN)   YAMAMOTO TOSHIRO(Yokohama City Univ. Medical Center, JPN)   SUZUKI NORIYUKI(Yokohama City Univ. Medical Center, JPN)   SUGIYAMA MITSUGI(Yokohama City Univ. Medical Center, JPN)   
Journal Title;Yokohama Medical Journal
Journal Code:G0703A
ISSN:0372-7726
VOL.56;NO.2;PAGE.141-144(2005)
Figure&Table&Reference;FIG.4, TBL.1, REF.6
Pub. Country;Japan
Language;Japanese
Abstract;This is a case report of grossly necrotic bowel with hepatic-portal venous gas. An 82-year-old woman with a history of hypertension, gallstone, reflux esophagitis and caesarian section, was brought to a hospital because of general fatigue, watery diarrhea, and vomiting. She was transferred to our center because abdominal contrast enhanced, computed tomography (CE-CT) scan showed arborescent dialation of the hepatic-portal venous gas and air around the abdominal aorta. Her conscious level was JCS-1, systolic blood pressure 42mmHg, pulse rate 146, respiration rate 32, and her body temperature 39.6.DEG.C.. She had abdominal tenderness and muscle guarding. CE-CT did not reveal any thrombus in the superior mesenteric artery. An emergency operation was performed and we found transmural bowel necrosis from 1 m distal to the Treitz ligament to the middle transverse colon and ischemic and cyanotic change of the descending and sigmoid colon. There was no perforation. We resected the necrotic bowel. Pathological examination showed small arterial spasms in the involved bowels. Although intensive care, including cytokine absorption therapy, blood transfusion, and continuous hemofiltration dialysis (CHDF) was given, she died the following day of multiple organ dysfunction syndrome (MODS). (author abst.)