Yamada Takeshi, Kan Hayato, Matsumoto Satoshi, Machida Tadashi, Koizumi Michihiro, Shinji Seiichi, Matsuda Akihisa, Yamagishi Aya, Yokoyama Yasuyuki, Uchida Eiji
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School.
J Nippon Med Sch. 2015;82(4):202-5. doi: 10.1272/jnms.82.202.
Portal venous gas has traditionally been considered an indicator of a poor prognosis due to bowel necrosis. Portal venous gas has recently been detected in patients with various clinical conditions, such as Crohn's disease, chemotherapy, and blunt abdominal injury without bowel necrosis. We herein report the first case of a patient with rectal cancer in whom portal venous gas developed after low anterior resection without anastomotic leakage or bowel necrosis. A 66-year-old man who had undergone low anterior resection started having severe diarrhea the day after the operation. A fever was present for 2 days after the operation but resolved on postoperative day 3. The patient complained of abdominal pain 5 days postoperatively. Computed tomography showed portal venous gas. Emergency open laparotomy was performed, but only limited ascites fluid without leakage or bowel necrosis was found. We irrigated the abdominal cavity and performed an ileostomy with insertion of a drainage tube in the rectovesical pouch. Only serous ascites was discharged through the drainage tube. The portal venous gas disappeared 3 days after the second operation. The patient was discharged in good condition 21 days after the first operation. Portal venous gas can develop after rectal surgery without anastomotic leakage or bowel necrosis. Conservative treatment is reasonable for patients without signs of bowel necrosis or panperitonitis. However, patients with portal venous gas must be carefully observed because portal venous gas may be life threatening.
门静脉气体传统上被认为是肠坏死预后不良的一个指标。最近在患有各种临床病症的患者中检测到门静脉气体，如克罗恩病、化疗以及钝性腹部损伤但无肠坏死的患者。我们在此报告首例直肠癌患者在低位前切除术后出现门静脉气体，且无吻合口漏或肠坏死。一名66岁男性接受低位前切除术后，术后第一天开始出现严重腹泻。术后发热2天，但术后第3天消退。患者术后5天诉腹痛。计算机断层扫描显示门静脉气体。进行了急诊剖腹探查，但仅发现有限的腹水，无漏液或肠坏死。我们冲洗了腹腔，并在直肠膀胱陷凹插入引流管进行回肠造口术。仅通过引流管引出浆液性腹水。第二次手术后3天门静脉气体消失。患者在第一次手术后21天状况良好出院。直肠癌手术后可在无吻合口漏或肠坏死的情况下出现门静脉气体。对于没有肠坏死或弥漫性腹膜炎体征的患者，保守治疗是合理的。然而，门静脉气体患者必须仔细观察，因为门静脉气体可能危及生命。
