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

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Tytuł:: Risk factors for bowel necrosis in patients with hepatic portal venous gas.
Autorzy:: Koami H; Department of Surgery, Center for Gastroenterology, Urasoe General Hospital, Iso 4-16-1, Urasoe, 901-2132, Japan, .
Isa T
Ishimine T
Kameyama S
Matsumura T
Yamada KC
Sakamoto Y
Źródło:: Surgery today [Surg Today] 2015 Feb; Vol. 45 (2), pp. 156-61. Date of Electronic Publication: 2014 Jun 01.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Original Publication: Tokyo : Springer International, c1992-
MeSH Terms:: Portal Vein*/diagnostic imaging
Gases/*blood
Intestinal Diseases/*etiology
Intestinal Diseases/*pathology
Intestine, Small/*pathology
Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography ; Necrosis ; Pneumatosis Cystoides Intestinalis ; Regression Analysis ; Retrospective Studies ; Risk Factors
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Substance Nomenclature:: 0 (Gases)
Entry Date(s):: Date Created: 20140602 Date Completed: 20150831 Latest Revision: 20211021
Update Code:: 20240104
PubMed Central ID:: PMC4293455
DOI:: 10.1007/s00595-014-0941-1
PMID:: 24880671
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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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