Hepatic portal venous gas after endoscopy in a patient with anastomotic obstruction  

作　　者：Ai Sadatomo Koji Koinuma Rihito Kanamaru Yasuyuki Miyakura Hisanaga Horie Alan T Lefor Yoshikazu Yasuda 

机构地区：[1]Department of Surgery,Jichi Medical University

出　　处：《World Journal of Gastrointestinal Surgery》2015年第2期21-24,共4页世界胃肠外科杂志（英文版）（电子版）

摘　　要：A 72-year-old male underwent a laparoscopic low anterior resection for advanced rectal cancer.A diverting loop ileostomy was constructed due to an anastomotic leak five days postoperatively.Nine months later,colonoscopy performed through the stoma showed complete anastomotic obstruction.The mucosa of the proximal sigmoid colon was atrophic and whitish.Ten days after the colonoscopy,the patient presented in shock with abdominal pain.Abdominal computed tomography scan showed hepatic portal venous gas(HPVG) and a dilated left colon.HPVG induced by obstructive colitis was diagnosed and a transverse colostomy performed emergently.His subsequent hospital course was unremarkable.Rectal anastomosis with diverting ileostomy is often performed in patients with low rectal cancers.In patients with anastomotic obstruction or severe stenosis,colonoscopy through diverting stoma should be avoided.Emergent operation to decompress the obstructed proximal colon is necessary in patients with a blind intestinal loop accompanied by HPVG.A 72-year-old male underwent a laparoscopic lowanterior resection for advanced rectal cancer. A divertingloop ileostomy was constructed due to an anastomoticleak five days postoperatively. Nine months later,colonoscopy performed through the stoma showedcomplete anastomotic obstruction. The mucosa ofthe proximal sigmoid colon was atrophic and whitish.Ten days after the colonoscopy, the patient presentedin shock with abdominal pain. Abdominal computedtomography scan showed hepatic portal venous gas（HPVG） and a dilated left colon. HPVG induced byobstructive colitis was diagnosed and a transversecolostomy performed emergently. His subsequenthospital course was unremarkable. Rectal anastomosiswith diverting ileostomy is often performed in patientswith low rectal cancers. In patients with anastomoticobstruction or severe stenosis, colonoscopy throughdiverting stoma should be avoided. Emergent operationto decompress the obstructed proximal colon isnecessary in patients with a blind intestinal loop accompaniedby HPVG.

关 键 词：Portal VENOUS gas ABDOMINAL COMPUTEDTOMOGRAPHY COLONOSCOPY Anastomotic OBSTRUCTION Bacterial TRANSLOCATION 

分 类 号：R735.37[医药卫生—肿瘤]