多量の肝内門脈ガスを呈した非閉塞性腸管虚血症の1例

An ８４-year-old woman was seen at the hospital because of sudden onset of epigastralgia, nausea, and vomiting. Blumberg’s sign and muscular rigidity were lacking, but an abdominal CT showed a massive amount of hepatic portal venous gas in the liver. Although portal venous gas in the liver disappeared on the abdominal CT the next day, high fever and muscular rigidity appeared. Based on these findings, we conducted an emergency laparotomy. Operative findings showed ascites and an ischemic, edemoatous jejunum about ５０ cm long. We resected the lesion and conducted anastomosis. Our final diagnosis was nonocclusive mesenteric ischemia（NOMI）. The case of portal venous gas was reported to be treated conservertively in several reports, but we should regard portal venous gas as a severe condition with poor prognosis, and bowel necrosis should be kept in mind.