A Case of Gangrenous Ischemic Colitis with Hepatic Portal Venous Gas Accompanied by Elevated Serum CEA

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  • 血清CEA高値を呈した門脈ガス血症を伴う壊死型虚血性腸炎の１例

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An 83–year–old man undergoing low anterior resection for rectal cancer 28 years earlier and seen for sudden–onset lower abdominal pain and vomiting showed tenderness, muscular guarding, and rebound tenderness in the lower left abdomen. Blood tests showed increased amylase, mild metabolic acidosis, and elevated CEA (18.2 ng/ml). Abdominal computed tomography (CT) showed portal venous gas patterns and a poorly enhanced left colon wall, necessitating emergency surgery for gangrenous ischemic colitis with portal venous gas. Left colectomy and transverse colostomy were con–ducted after left colon necrosis and 400 ml of malodorous brownish–red ascites were found. Endotoxin was absorbed immediately after surgery, the man's general condition stabilized, and he was discharged on postoperative day 36. Pathological findings showed mucosa and submucosa necrosis. Decreased blood flow when the inferior mesenteric artery was ligated in rectal cancer surgery helped concomitantly increase internal intestinal tract pressure due to constipation and enema, causing necrosis and portal venous gas. Serum CEA may have risen when CEA–rich mucosa became necrotic and burst, releasing CEA into the blood.

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