A Case Report of Crohn's Disease Complicated with Ileum Perforation Leading to Superior Mesenteric Vein Thrombosis and Hepatic Portal Venous Gas

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  • 門脈ガス血症と上腸間膜静脈血栓症を合併したCrohn病の1例
  • 症例 門脈ガス血症と上腸間膜静脈血栓症を合併したCrohn病の1例
  • ショウレイ モンミャク ガス ケッショウ ト ジョウチョウカンマク ジョウミャク ケッセンショウ オ ガッペイ シタ Crohnビョウ ノ 1レイ

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We report a 31-year-old woman who had been treated with oral administration for Crohn's disease and was admitted to our hospital due to lower abdominal pain. She exhibited extreme tenderness in the right lower flank with a high fever of 40.4°C, but no peritoneal signs. Abdominal computed tomography revealed free air adjacent to the ileocecum, several collections of gas in the peripheral branches of hepatic portal veins, and superior mesenteric venous thrombus. Emergency open laparotomy was performed under a diagnosis of ileal perforation accompanied by exacerbation of Crohn's disease. Since laparotomy disclosed funicular indurations of the ileocolic vein and last branch of the ileal vein, ileocecal resection was performed. Histopathological findings showed perforation of the terminal ileum with a longitudinal ulcer, which is compatible with Crohn's disease. The venous thrombus was formed due to septic thrombophlebitis. Intravenous infusion of heparin was administered continuously right after the operation. Postoperative course was uneventful and the patient was discharged on postoperative day 28. Hepatic portal venous gas used to be well known as a severe complication of ischemic bowel disease, but some cases are complicated with Crohn's disease. In our case, early diagnosis and decision to perform emergency laparotomy enabled the patient to achieve an excellent prognosis.

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