Tomioka Akira, Narimatsu Kazuyuki, Chiya Nanoka, Nishimura Hiroyuki, Akita Yoshihiro, Higashiyama Masaaki, Komoto Shunsuke, Tomita Kengo, Hokari Ryota
Division of Gastroenterology National Defense Medical College Hospital Saitama Japan.
DEN Open. 2022 Apr 1;2(1):e107. doi: 10.1002/deo2.107. eCollection 2022 Apr.
Hepatic portal venous gas (HPVG) is considered to be a sign of poor prognosis in abdominal diseases and a potentially fatal condition. However, HPVG after colonic endoscopic submucosal dissection (ESD), is an even rarer complication that there is just one report of it at the moment. In this report, we present a case of HPVG and bacteremia that happened a day after colonic ESD in the descending colon. A 79-year-old female was referred to perform endoscopic treatment for a 40-mm elevated tumor in the descending colon and surgery for clinical T1b cancer in the rectosigmoid colon. With a preoperative diagnosis of intramucosal carcinoma in adenoma, we performed ESD using carbon dioxide insufflation. The tumor was resected en bloc without any adverse events including perforation. On the following day, shivering and a fever of 38°C suddenly developed with no abdominal symptoms. Computed tomography revealed the presence of HPVG and gas in the middle colic vein without pneumoperitoneum. The patient was managed conservatively with fasting and intravenous antibiotic treatment. We confirmed the disappearance of the findings with computed tomography on the next day of the first computed tomography and with a colonoscope, we observed the base of ESD ulcer 5 days post-ESD. HPVG might be treated conservatively, but it might cause more severe conditions such as air embolism, so this rare complication still needs to be thoroughly monitored.
肝门静脉积气（HPVG）被认为是腹部疾病预后不良的征象以及一种潜在的致命状况。然而，结肠内镜黏膜下剥离术（ESD）后出现HPVG是一种更为罕见的并发症，目前仅有一例相关报道。在本报告中，我们呈现了一例降结肠ESD术后一天发生的HPVG和菌血症病例。一名79岁女性因降结肠有一个40毫米的隆起性肿瘤而被转诊接受内镜治疗，并因直肠乙状结肠临床T1b期癌症接受手术。术前诊断为腺瘤内黏膜内癌，我们采用二氧化碳充气进行了ESD。肿瘤被完整切除，未发生包括穿孔在内的任何不良事件。术后第二天，患者突然出现寒战和38°C发热，无腹部症状。计算机断层扫描显示存在HPVG且中结肠静脉内有气体，无气腹。患者接受禁食和静脉抗生素治疗的保守处理。在首次计算机断层扫描后的第二天，通过计算机断层扫描我们确认了相关表现消失，并且在ESD术后5天，通过结肠镜观察了ESD溃疡的底部。HPVG可能可通过保守治疗，但它可能引发更严重的状况如空气栓塞，所以这种罕见并发症仍需密切监测。
