Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2015; 7(2): 21-24
Published online Feb 27, 2015. doi: 10.4240/wjgs.v7.i2.21
Hepatic portal venous gas after endoscopy in a patient with anastomotic obstruction
Ai Sadatomo, Koji Koinuma, Rihito Kanamaru, Yasuyuki Miyakura, Hisanaga Horie, Alan T Lefor, Yoshikazu Yasuda
Ai Sadatomo, Koji Koinuma, Rihito Kanamaru, Yasuyuki Miyakura, Hisanaga Horie, Alan T Lefor, Yoshikazu Yasuda, Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan
Author contributions: All authors contributed to this manuscript.
Ethics approval: This study was approved by the Institutional Review Board of Jichi Medical School for ethical issues.
Informed consent: The patient provided informed written consent prior to submit the manuscript.
Conflict-of-interest: We certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ai Sadatomo, MD, Graduate Student, Department of Surgery, Jichi Medical University, 3311 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan. r0626as@jichi.ac.jp
Telephone: +81-285-587371 Fax: +81-285-443234
Received: July 12, 2014
Peer-review started: July 13, 2014
First decision: September 28, 2014
Revised: December 16, 2014
Accepted: January 9, 2015
Article in press: January 12, 201
Published online: February 27, 2015
Processing time: 213 Days and 20.8 Hours
Abstract

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.

Keywords: Portal venous gas; Abdominal computed tomography; Colonoscopy; Anastomotic obstruction; Bacterial translocation

Core tip: A rare case of hepatic portal venous gas (HPVG) is reported. Endoscopy through ileostomy leaded the formation of HPVG induced by obstructive colitis. The anastomosis of rectum was totally obstructed after rectum cancer operation. For nine months, the mucosa of ascending to sigmoid colon has changed atrophy for disuse. The patient’s condition improved after emergent operation of transverse colostomy. In patients with anastomotic obstruction or severe stenosis, colonoscopy through diverting stoma should be avoided.