Exploring the use of single-port surgery in the conservative management of hepatic portal vein gas

Taniguchi, Kohei; Asakuma, Mitsuhiro; Nagayabu, Kazuya; Takashima, Syogo; Iida, Ryo; Hirokawa, Fumitoshi; Umegaki, Osamu; Neo, Masashi; Takasu, Akira; Uchiyama, Kazuhisa

doi:10.1097/md.0000000000013368

Cited by 4 publications

(2 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CT scans are highly-sensitive tools for detecting PVG and PI [3,4,7,28]. Moreover, contrast-enhanced CT imaging is a useful investigative tool for identifying the underlying disease, especially bowel ischemia and gastrointestinal perforation [18,28,29]. We assessed representative CT ndings of acute abdominal disease.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association of Contrast-Enhanced CT Findings with Etiology and Outcome in Patients with Portal Venous Gas and Pneumatosis Intestinalis: A Single Center Case Series Study

Yoshida¹,

Sadakari²,

Tamehiro³

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Contrast-enhanced computed tomography (CT) is a reliable diagnostic tool often used to investigate the etiology of portal venous gas (PVG) and pneumatosis intestinalis (PI). However, there are few reports that offer an analysis of the relationship between particular CT findings and clinical outcomes. In this paper, we sought to close that gap and present the results of our analyses that reveal which CT findings are correlated with life-threatening cases.Methods: 39 patients were diagnosed with PVG or PI from contrast-enhanced CT scans and underwent treatment at St. Mary’s Hospital from January 2009 to December 2018. We reviewed patients’ medical charts, laboratory data, and CT scan images retrospectively. We defined cases resulting in operation or death as group 1, and patients with conservative treatment who survived as group 2. We then analyzed the relationship between each CT finding and clinical feature.Results: The primary underlying diseases identified for PVG and PI were bowel ischemia (13/39), enteritis (9/39), constipation (5/39), iatrogenic disease (4/39), and hemodialysis (3/39). Poor enhancement of the intestinal wall and extrahepatic venous gas were correlated with bowel ischemia (p=0.0002 and p=0.0003, respectively). Free air was less correlated with bowel ischemia (p=0.02). Wall thickness was correlated with enteritis (p=0.02). Mortality in cases with bowel ischemia and perforation was quite high (60%) even if patients underwent surgery (33.3%). Conversely, patients with enteritis, constipation, hemodialysis and gastric dilatation who did not require surgery resulted in more favorable outcomes with conservative treatment. In the multivariate analysis, extra hepatic venous gas was the only solitary factor correlated with group 1 (p=0.0008).Conclusions: Extra hepatic venous gas was the strongest predictive factor of clinical outcome in contrast-enhanced CT findings correlated with bowel ischemia and required surgical treatment. The other CT findings were useful in diagnosing the underlying disease, but were not correlated with clinical outcomes. The necessity for surgical treatment remains dependent on the root cause.

show abstract

Section: Discussionmentioning

confidence: 99%

“…2). Some authors also reported that wide spread PVG was correlated with poor prognosis [5,13,17,29]. From a pathophysiological standpoint, wide spread PVG often indicates progressive mucosal damage and can re ect the severity of the patient's condition [32].…”

Section: Discussionmentioning

confidence: 99%

Association of Contrast-Enhanced CT Findings with Etiology and Outcome in Patients with Portal Venous Gas and Pneumatosis Intestinalis: A Single Center Case Series Study

Yoshida¹,

Sadakari²,

Tamehiro³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

Portal Venous Gas in Adults: Clinical Significance, Management, and Outcomes of 25 Consecutive Patients

et al. 2021

View full text Add to dashboard Cite

Background Portal venous gas (PVG) is considered a rare finding with a grave prognosis. The most common and critical underlying pathology of PVG is bowel necrosis. However, bowel necrosis is sometimes difficult to properly diagnose. We retrospectively analyzed data of patients that contributed to the decision to perform emergency operation and bowel resection. Methods Between 2009 and 2019, 25 consecutive adult patients with PVG were retrospectively identified. Patients were divided into the Operation and Non-operation groups. The Operation group was further subdivided into the Bowel resection and Non-resection groups. Clinical, laboratory and radiographic parameters were analyzed. Results Conservative management was successful for 32% (8/25) of patients (Non-operation group: mortality 0%). Sixty-eight percent (17/25) were surgically managed (Operation group: mortality 35.3%). In the Operation group, 52.9% (9/17) underwent bowel resection (Bowel resection group: mortality 55.6%); however, bowel resection was unnecessary in 47.1% (8/17) of cases (Non-resection group: mortality 12.5%). A univariate analysis revealed significant differences in GCS, APACHE II, abdominal distention, CRP, lactate, and CT findings of dilatation of bowel, pneumatosis intestinalis, and attenuation of contrast effect of the bowel wall between the Operation and Non-operation groups. However, there were no significant differences between the Bowel resection and Non-resection groups, with the exception of GCS. Conclusions 3 Clinical, laboratory and radiographic parameters can inform decisions on conservative management. However, 47.1% of patients who underwent surgery for suspected bowel necrosis did not require bowel resection, suggesting that this approach alone may not be sufficient to avoid non-therapeutic laparotomy. A new approach should therefore be developed to improve this situation.

show abstract

Surgical anatomy of the right portal vein

Дмитриев

Черкасов

Перескоков

et al. 2020

Khir. Z. im. N.I. Pirogova

View full text Add to dashboard Cite

Exploring the use of single-port surgery in the conservative management of hepatic portal vein gas

Abstract: Supplemental Digital Content is available in the text

Cited by 4 publications

References 16 publications

Association of Contrast-Enhanced CT Findings with Etiology and Outcome in Patients with Portal Venous Gas and Pneumatosis Intestinalis: A Single Center Case Series Study

Association of Contrast-Enhanced CT Findings with Etiology and Outcome in Patients with Portal Venous Gas and Pneumatosis Intestinalis: A Single Center Case Series Study

Portal Venous Gas in Adults: Clinical Significance, Management, and Outcomes of 25 Consecutive Patients

Surgical anatomy of the right portal vein

Contact Info

Product

Resources

About