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Vol. 86. Issue 3.
Pages 307-308 (July - September 2021)
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Vol. 86. Issue 3.
Pages 307-308 (July - September 2021)
Clinical image in Gastroenterology
DOI: 10.1016/j.rgmxen.2021.05.012
Open Access
Alpha-glucosidase inhibitor-induced portal venous gas: Not always an indication for surgery
Gas en vena porta inducido por inhibidor de alfa glucosidasa: no siempre es indicación para cirugía
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H. Ito
Corresponding author
itohirokan@yahoo.co.jp

Corresponding author at: División de Medicina Hospitalaria, Hospital de la Universidad de Tsukuba 2-1-1 Amakubo, Tsukuba, lbaraki 305-8576, Japan. Tel.: +8 1-29-853-3900.
División de Medicina Hospitalaria, Universidad de Tsukuba, Hospital Tsukuba, Ibaraki, Japan
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An 81-year-old man with a history of type 2 diabetes mellitus was admitted to our hospital because of abdominal bloating. He had started taking voglibose six days earlier. Physical examination showed abdominal distension, but no abdominal tenderness. Contrast-enhanced abdominal computed tomography revealed an expanded intestinal tract and portal emphysema (Fig. 1). Voglibose was suspended, and the patient underwent emergency laparotomy for suspected non-occlusive mesenteric ischemia. However, there were no signs of intestinal necrosis or perforation (Fig. 2). Bowel decompression was then performed. Computed tomography was carried out on the seventh day of hospitalization, showing no portal emphysema (Fig. 3), and oral diet was started on day 10. The patient’s clinical course was uneventful, and he was transferred to a long-term care hospital on day 24. Portal venous gas has been known to be a rare complication in patients taking alpha-glucosidase inhibitors (α-GIs) and could result from pneumatosis cystoides intestinalis, rather than intestinal ischemia.1,2 It can be managed conservatively, and unnecessary surgical treatment should be avoided.

Figure 1.

Contrast-enhanced abdominal computed tomography scan, showing the expanded intestinal tract and portal emphysema (arrow).

(0.06MB).
Figure 2.

Emergency laparotomy revealed no signs of intestinal necrosis or perforation.

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Figure 3.

Contrast-enhanced computed tomography scan taken on the seventh day of hospitalization, showing no portal emphysema.

(0.07MB).
Ethical considerations

Written informed consent was obtained from the patient for publication of this article. Because the present work is a case report, no authorization by the institution’s ethics committee was required.

Financial disclosure

No financial support was received in relation to this article.

Conflict of interest

The author declares that there is no conflict of interest.

Acknowledgements

The author wishes to thank S. Kawano for his support in daily clinical practice.

References
[1]
H. Makiyama, R. Kataoka, M. Tauchi, et al.
Do alpha-glucosidase inhibitors have the potential to induce portal venous gas? -Two clinical case reports.
Intern Med., 53 (2014), pp. 691-694
[2]
A. Rottenstreich, Y. Agmon, R. Elazary.
A rare case of benign pneumatosis intestinalis with portal venous gas and pneumoperitoneum induced by acarbose.
Intern Med., 54 (2015), pp. 1733-1736

Please cite this article as: Ito H. Gas en vena porta inducido por inhibidor de alfa glucosidasa: no siempre es indicación para cirugía. Revista de Gastroenterología de México. 2021;86:307–308.

Copyright © 2021. Asociación Mexicana de Gastroenterología
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