Hepatic portal venous gas which is associated with a variety of gastrointestinal disorders is relatively rare entity. It is said to be a sign of poor prognosis. This time we have experienced a case of strangulated ileus of the small intestine due to mesenteric hiatal hernia with hepatic portal venous gas.
A 62-year-old man presented with abrupt onset of abdominal pain. On admission, an abdominal CT scan revealed no hepatic portal venous gas and intestinal obstruction was diagnosed. Abdominal pain became worse and another abdominal CT scan on the next day offered a diagnosis of hepatic portal venous gas due to intestinal necrosis. An emergency operation was performed. At surgery, a hiatus was present on the small bowel mesentery. A wide-ranging resection of the small intestine was performed due to strangulated ileus. Postoperative course was uneventful. Abdominal CT scan is of value in diagnosing hepatic portal venous gas that indicates the presence of severe intestinal necrosis. Emergency laparotomy, however, appears to yield the patient a good prognosis.