-Case Reports-

A Case of Portal Venous Gas after Rectal Surgery without Anastomotic Leakage or Bowel Necrosis

Takeshi Yamada¹, Hayato Kan¹, Satoshi Matsumoto², Tadashi Machida³, Michihiro Koizumi¹, Seiichi Shinji¹, Akihisa Matsuda², Aya Yamagishi¹, Yasuyuki Yokoyama¹ and Eiji Uchida¹

¹Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
²Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
³Department of Radiology, Nippon Medical School

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.

J Nippon Med Sch 2015; 82: 202-205

Keywords
portal venous gas, rectal cancer

Correspondence to
Takeshi Yamada, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
y-tak@nms.ac.jp

Received, October 28, 2014
Accepted, December 26, 2014