Indications for Conservative Treatment in Patients with Hepatic Portal-venous Gas

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 44; no. 11; pp. 1355 - 1361
• Main Authors: Yamayoshi, Takatomo, Onizuka, Koji, Kidogawa, Hideo, Ito, Shigehiko
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 2011
• Subjects: Conservative treatment; Hepatic portal-venous gas
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.44.1355

Introduction : There have been some reports on cases of hepatic portal-venous gas with mild symptoms that were detected using recently-developed diagnostic imaging techniques. Among these patients, for whom conservative treatment is provided, the prognosis of this disease is sometimes good. In actual emergency medical care of these patients, however, it is not easy to determine whether to implement emergency laparotomy or conservative treatment. In this study, we examined the indications for conservative treatment for cases of hepatic portal-venous gas based on blood biochemical findings obtained upon the initial visit. Methods : The subjects were 14 patients with hepatic portal-venous gas who were treated at our hospital. We compared Group A, in which conservative treatment could not be provided because of confirmed intestinal necrosis, with Group B, which consented of other cases for which conservative treatment was provided. Results : In the comparison between Groups A and B, the CRP levels were increased significantly in Group A, while the BE was significantly lower in Group B. Conclusion : Patients who exhibit BE of -3.0 mmol/l or lower, or CRP of 15 mg/dl or higher must undergo emergency abdominal surgery due to the possibility of intestinal necrosis.