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. 2015 Feb;45(2):156-61.
doi: 10.1007/s00595-014-0941-1. Epub 2014 Jun 1.

Risk factors for bowel necrosis in patients with hepatic portal venous gas

Hiroyuki Koami  1 , Tsutomu Isa, Tomonari Ishimine, Shinichiro Kameyama, Toshinobu Matsumura, Kosuke Chris Yamada, Yuichiro Sakamoto
Affiliations

Risk factors for bowel necrosis in patients with hepatic portal venous gas

Hiroyuki Koami et al. Surg Today. 2015 Feb.

Abstract

Purpose: To evaluate the risk factors for bowel necrosis in adult patients with hepatic portal venous gas (HPVG).

Methods: This retrospective study comprised 33 adult patients treated for HPVG between August, 2008 and December, 2011. The patients were divided into a necrotic group (n = 14) and a non-necrotic group (n = 19). We analyzed the clinical demographics, laboratory data, multi-detector computed tomography findings, treatments, and outcomes in each group.

Results: Abdominal pain, peritoneal signs, systolic blood pressure, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase (LDH), small intestinal dilatation, poor enhancement of the bowel wall, and intestinal pneumatosis were all significantly associated with bowel necrosis. Moreover, there were significantly more operative cases and deaths in the necrotic group. Multivariate analysis revealed that systolic BP (p = 0.048), LDH (p = 0.022), and intestinal pneumatosis (p = 0.038) were independent risk factors for bowel necrosis. Thus, we created new diagnostic criteria for bowel necrosis based on these three factors, the sensitivity, specificity, and accuracy of which were 100, 78.9, and 87.9 %, respectively.

Conclusions: This study demonstrates new and important findings to evaluate the risk factors for bowel necrosis. Using our diagnostic criteria, the indications for emergency laparotomy can be established more accurately.

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Figures

Fig. 1
Fig. 1
Multi-detector computed tomography (MDCT) findings of the patients with hepatic portal venous gas (HPVG)
Fig. 2
Fig. 2
Study design. Thirty-three patients were divided into two groups based on the presence of bowel necrosis/ischemia
Fig. 3
Fig. 3
Receiver-operating characteristic (ROC) curves for detecting bowel necrosis according to systolic blood pressure (BP) (a) and lactate dehydrogenase (LDH) (b). ROC receiver-operating characteristic, AUC area under the curve, BP blood pressure, LDH lactate dehydrogenase
Fig. 4
Fig. 4
Number of abnormal parameters in the two groups (a). New diagnostic criteria for bowel necrosis in the patients with hepatic portal venous gas (HPVG) (b). According to our criteria, positive bowel necrosis was defined by more than two abnormal findings. The sensitivity was 100 %, the specificity was 78.9 % and the accuracy was 87.9 %. HPVG hepatic portal venous gas, BP blood pressure, LDH lactate dehydrogenase
See this image and copyright information in PMC

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