Yamadera Masato, Kajiwara Yoshiki, Shinto Eiji, Hokari Ryota, Shimazaki Hideyuki, Yamamoto Junji, Hase Kazuo, Ueno Hideki
Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan.
Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan.
Surg Case Rep. 2016 Dec;2(1):66. doi: 10.1186/s40792-016-0193-y. Epub 2016 Jun 28.
An 80-year-old man presented in another hospital with acute abdominal pain; computed tomography indicated hepatic portal venous gas (HPVG) and small intestinal thickening. He was then transferred to our hospital, where we diagnosed idiopathic inflammation and stenosis of the ileum. Because the patient's abdominal symptoms were mild and his general condition was good, we chose to administer conservative therapy. His condition improved and we discharged him from our hospital. However, he was hospitalized again 9 days later because his abdominal pain had recurred and was worse. We performed a laparoscopic partial resection of the ileum 3 weeks after the patients' initial presentation. Macroscopically, longitudinal ulcers were observed near the stenosis of the ileum; the segment of the small intestine that contained the ulcers was removed, and subsequent pathological findings indicated Crohn's disease of the small intestine. The post-operative course was favorable, and the patient was discharged on post-operative day 9. Such serendipitous diagnosis of small intestinal Crohn's disease in an elderly patient with hepatic portal venous gas is rare; to our knowledge, this is the first of such case in which laparoscopic surgery was performed.
一名80岁男性因急性腹痛在另一家医院就诊；计算机断层扫描显示肝门静脉积气（HPVG）和小肠增厚。随后他被转至我院，我们诊断为回肠特发性炎症和狭窄。由于患者腹部症状较轻且一般状况良好，我们选择进行保守治疗。他的病情有所改善，随后出院。然而，9天后他因腹痛复发且加重再次入院。在患者首次就诊3周后，我们为其进行了腹腔镜下部分回肠切除术。肉眼可见，在回肠狭窄附近观察到纵向溃疡；切除包含溃疡的小肠段，随后的病理结果表明为小肠克罗恩病。术后过程顺利，患者于术后第9天出院。在患有肝门静脉积气的老年患者中如此偶然地诊断出小肠克罗恩病很罕见；据我们所知，这是首例进行腹腔镜手术的此类病例。
