Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2020; 26(14): 1628-1637
Published online Apr 14, 2020. doi: 10.3748/wjg.v26.i14.1628
Optimal treatment strategies for hepatic portal venous gas: A retrospective assessment
Masanori Gonda, Tatsuya Osuga, Yoshihiro Ikura, Kazunori Hasegawa, Kentaro Kawasaki, Takatoshi Nakashima
Masanori Gonda, Tatsuya Osuga, Kazunori Hasegawa, Takatoshi Nakashima, Department of Gastroenterology, Takatsuki General Hospital, Takatsuki 5691192, Japan
Yoshihiro Ikura, Department of Pathology, Takatsuki General Hospital, Takatsuki 5691192, Japan
Kentaro Kawasaki, Department of Surgery, Takatsuki General Hospital, Takatsuki 5691192, Japan
Author contributions: Gonda M, Osuga T and Hasegawa K contributed to study concept and design; Gonda M and Osuga T contributed to data collection; Gonda M, Osuga T and Ikura Y contributed to data verification; Osuga T and Ikura Y contributed to data management, interpretation and supervision; Osuga T and Ikura Y contributed to statistical analysis and drafted the manuscript; Kawasaki K and Nakashima T contributed to critical revision of the manuscript.
Institutional review board statement: The institutional review boards in Takatsuki General Hospital (Approval No: 2018-1) approved this study including an opt-out method of informed consent.
Informed consent statement: Patient’s consent was obtained through the opt-out method instead of a written form.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Tatsuya Osuga, MD, PhD, Chief Physician, Doctor, Postdoc, Department of Gastroenterology, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki 5691192, Japan.
Received: December 26, 2019
Peer-review started: December 26, 2019
First decision: February 18, 2020
Revised: March 25, 2020
Accepted: April 1, 2020
Article in press: April 1, 2020
Published online: April 14, 2020
Research background

Hepatic portal venous gas (HPVG) is generally recognized as a life-threatening sign in patients with serious intestinal damage. While most of such patients require surgical treatments, some patients can recover without surgery.

Research motivation

We aimed to establish an optimal treatment strategy for HPVG, i.e., how to select surgical or conservative treatments.

Research objectives

We tested accuracy of our original computed tomography (CT)-based selection criteria. Additionally, we found if there were reliable prognostic factors in non-surgical cases.

Research methods

Thirty-four cases of HPVG were included. Surgical indication had been decided by CT findings, including free-air, embolism, lack of contrast enhancement of the intestinal wall, and intestinal pneumatosis. Their clinical findings and treatment outcomes were analyzed separately in the surgical cases and non-surgical cases.

Research results

Of eight surgical cases, seven patients (87.5%) survived but one (12.5%) died. All the surgical patients had severe intestinal damage and the necrotic portions were resected. In addition to 14 cases without surgical indication, 12 inoperable cases were defined as non-surgical cases (total 26 cases). Three (25%) of the 12 inoperable patients survived. Only one patient (7%) died among the 14 patients diagnosed as being surgery unnecessary. Comparative 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 cases. The mortality was 90% if two or all of these three clinical findings were detected.

Research conclusions

Our CT-based criteria were useful to determine the surgical indication for HPVG patients. In non-surgical cases, ascites, peritoneal irritation signs and shock were closely associated with poor prognoses, and are applicable as predictors of patients’ prognoses.

Research perspectives

Our two-step decision and prediction process may be applicable not only for selection of surgical cases but also for considering non-surgical but intensive treatments for such inoperable patients.