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A 62-year-old man was admitted due to long-shallow gastric ulcers (Picture 1). He was on various medications including warfarin. After admission, during which warfarin was stopped, he had a mild cerebral infarction, thus a heparin infusion was started (12,000 U/day). On day 20 he resumed meals and had short-term periumbilical pain. Computed tomography revealed portal venous gas (PVG) that disappeared the next day without intestinal ischemic change, and severe arteriosclerotic stenoses at both trunks of the superiorand inferior-mesenteric artery (SMA and IMA) (Picture 2). While the heparin dose was increased to 18,000 U/day, the same episode occurred two more times (Picture 3). Since capsule endoscopy after the third PVG showed multiple ischemic areas in the distal jejunum (Picture 4; upperpanels), oral administration of clopidogrel and beraprost so-

Three Times Repeated Portal Venous Gas after Meals