TY - JOUR
T1 - A case of acute gastric mucosal lesion and acute perforated necrotic cholecystitis that combined portal venous gas
AU - Mitsui, Kazuhiro
AU - Namiki, Kenji
AU - Matsumoto, Hiroshi
AU - Konno, Fumihiro
AU - Yoshida, Ryuuichi
AU - Takahashi, Takehiro
AU - Kokaguchi, Kyosuke
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2007/4
Y1 - 2007/4
N2 - A 87-year-old man seen in an emergency for sudden onset upper right quadrant pain, coffee-ground vomiting and a medical history of hypertension was found to have tenderness and muscle guarding in the upper right quadrant. Laboratory data showed WBC 23,700/μl, CRP 22.28mg/dl, and severe inflammation. Plain abdominal X-ray showed marked gastric dilation. Abdominal computed tomography showed widespread hepatic portal venous gas in the liver and portal venous gas in the gastric border vein, splenic vein, and superior mesenteric vein, and gas imaging in the gastric wall. The gallbladder was distended and edematous and showed fluid collection around the gallbladder. We conducted emergency laparoscopic exploration for gastrointestinal necrosis or possible acute cholecystitis, then laparoscopic cholecystectomy under an intraoperative diagnosis of acute perforated necrotic cholecystitis. Postoperative gastroduodenal endoscopy showed multiple erosions with an ulcer in the gastric subcardia and antrum of the stomach. The man was definitively diagnosed with acute perforated necrotic cholecystitis combining broad portal venous gas due to an acute gastric mucosal lesion and gastric dilation and discharged on postoperative day 16.
AB - A 87-year-old man seen in an emergency for sudden onset upper right quadrant pain, coffee-ground vomiting and a medical history of hypertension was found to have tenderness and muscle guarding in the upper right quadrant. Laboratory data showed WBC 23,700/μl, CRP 22.28mg/dl, and severe inflammation. Plain abdominal X-ray showed marked gastric dilation. Abdominal computed tomography showed widespread hepatic portal venous gas in the liver and portal venous gas in the gastric border vein, splenic vein, and superior mesenteric vein, and gas imaging in the gastric wall. The gallbladder was distended and edematous and showed fluid collection around the gallbladder. We conducted emergency laparoscopic exploration for gastrointestinal necrosis or possible acute cholecystitis, then laparoscopic cholecystectomy under an intraoperative diagnosis of acute perforated necrotic cholecystitis. Postoperative gastroduodenal endoscopy showed multiple erosions with an ulcer in the gastric subcardia and antrum of the stomach. The man was definitively diagnosed with acute perforated necrotic cholecystitis combining broad portal venous gas due to an acute gastric mucosal lesion and gastric dilation and discharged on postoperative day 16.
KW - Acute perforated necrotic cholecystitis
KW - Laparoscopic exploration
KW - Portal venous gas
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U2 - 10.5833/jjgs.40.433
DO - 10.5833/jjgs.40.433
M3 - Article
AN - SCOPUS:34247170023
VL - 40
SP - 433
EP - 437
JO - Japanese Journal of Gastroenterological Surgery
JF - Japanese Journal of Gastroenterological Surgery
SN - 0386-9768
IS - 4
ER -