Optimal treatment strategies for hepatic portal venous gas:A retrospective assessment

作     者：Masanori Gonda Tatsuya Osuga Yoshihiro Ikura Kazunori Hasegawa Kentaro Kawasaki Takatoshi Nakashima 

作者机构：Department of GastroenterologyTakatsuki General HospitalTakatsuki 5691192Japan Department of PathologyTakatsuki General HospitalTakatsuki 5691192Japan Department of SurgeryTakatsuki General HospitalTakatsuki 5691192Japan 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2020年第26卷第14期

页      面：1628-1637页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：Department of Radiology Takatsuki General Hospital 

主　　题：Hepatic portal venous gas Surgical treatment Conservative treatment Computed tomography Intestinal necrosis Prognostic factor 

摘      要：BACKGROUND Hepatic portal venous gas(HPVG)generally indicates poor prognoses in patients with serious intestinal *** surgical removal of the damaged portion is effective,some patients can recover with conservative *** To establish an optimal treatment strategy for HPVG,we attempted to generate computed tomography(CT)-based criteria for determining surgical indication,and explored reliable prognostic factors in non-surgical *** Thirty-four cases of HPVG(patients aged 34-99 years)were *** for surgery had been determined mainly by CT findings(***-air,embolism,lack of contrast enhancement of the intestinal wall,and intestinal pneumatosis).The clinical data,including treatment outcomes,were analyzed separately for the surgical cases and non-surgical *** Laparotomy was performed in eight cases(surgical cases).Seven patients(87.5%)survived but one(12.5%)*** each case,severe intestinal damage was confirmed during surgery,and the necrotic portion,if present,was ***-occlusive mesenteric ischemia was the most common cause(n=4).Twentysix cases were treated conservatively(non-surgical cases).Surgical treatments had been required for twelve but were abandoned because of the patients’poor general ***,however,three(25%)of the twelve inoperable patients *** remaining 14 of the 26 cases were diagnosed originally as being sufficiently cured by conservative treatments,and only one patient(7%)*** analyses of the fatal(n=10)and recovery(n=16)cases revealed that ascites,peritoneal irritation signs,and shock were significantly more frequent in the fatal *** mortality was 90%if two or all of these three clinical findings were *** HPVG related to intestinal necrosis requires surgery,and our CT-based criteria are probably useful to determine the surgical *** non-surgical cases,ascites,peritoneal irritation signs and shock were closely associated