• Hypercoagulability
• Intestinal ischemia
• Mesenteric venous thrombosis
• Prognostic factors
• Thrombophilia

• Male
• Humans
• Female
• Aged
• Mesenteric Ischemia/diagnostic imaging
• Mesenteric Ischemia/surgery
• Mesenteric Ischemia/complications
• Venous Thrombosis/diagnostic imaging
• Venous Thrombosis/surgery
• Venous Thrombosis/complications
• Thrombophilia/complications
• Thrombosis
• Ischemia/complications
• Retrospective Studies

• apache ii
• factor analysis
• mesenteric ischemia
• organ dysfunction scores
• simplified acute physiology score
• statistical analysis

• Humans
• Retrospective Studies
• Mesenteric Ischemia
• ROC Curve
• APACHE
• Prognosis
• Hospital Mortality
• Intensive Care Units

• biventricular heart failure
• cardiac surgery
• cardio-intestinal syndrome
• intensive care unit
• sepsis

• Acute Physiology and Chronic Health Evaluation II score
• Acute mesenteric venous thrombosis
• Irreversible intestinal ischemia
• Leukocytosis
• Surgical resection
• Transcatheter thrombolysis

• Acute Disease
• Humans
• Mesenteric Ischemia/diagnostic imaging
• Mesenteric Ischemia/surgery
• ROC Curve
• Retrospective Studies
• Vascular Surgical Procedures

• Computed tomography
• Conservative treatment
• Hepatic portal venous gas
• Intestinal necrosis
• Prognostic factor
• Surgical treatment

• Adult
• Aged
• Aged, 80 and over
• Ascites/diagnosis
• Ascites/etiology
• Ascites/mortality
• Ascites/therapy
• Conservative Treatment/statistics & numerical data
• Embolism, Air/diagnosis
• Embolism, Air/etiology
• Embolism, Air/mortality
• Embolism, Air/therapy
• Female
• Gases
• Humans
• Intestinal Mucosa/diagnostic imaging
• Intestinal Mucosa/pathology
• Intestinal Mucosa/surgery
• Male
• Mesenteric Ischemia/complications
• Mesenteric Ischemia/diagnosis
• Mesenteric Ischemia/mortality
• Mesenteric Ischemia/therapy
• Necrosis/complications
• Necrosis/diagnosis
• Necrosis/mortality
• Necrosis/surgery
• Pneumatosis Cystoides Intestinalis/diagnosis
• Pneumatosis Cystoides Intestinalis/etiology
• Pneumatosis Cystoides Intestinalis/mortality
• Pneumatosis Cystoides Intestinalis/therapy
• Portal Vein/diagnostic imaging
• Portal Vein/surgery
• Prognosis
• Retrospective Studies
• Risk Factors
• Shock/diagnosis
• Shock/etiology
• Shock/mortality
• Shock/therapy
• Tomography, X-Ray Computed
• Treatment Outcome

• bowel necrosis
• mesenteric ischemia
• pneumatosis intestinalis
• portal venous gas

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Hepatic portal venous gas (HPVG) is believed to be an indication for emergent surgery because it is associated with high mortality rate.

Hepatic portal venous gas (HPVG) is believed to be an indication for emergent surgery because it is associated with high mortality rate. However, the recent increase in the use of modern abdominal computed tomography (CT) has resulted in the detection of HPVG in more benign conditions. Therefore, the decision-making process whether we chose emergent surgery or conservative treatment without surgery is important for the patients with HPVG.

An 84-year-old male was referred to our hospital due to the sudden onset of abdominal pain and massive hepatic portal vein gas on emergent CT. The Acute Physiology and Chronic Health Evaluation (APACHE) II Score was calculated as 17; slightly elevated comparing with the other cases who were successfully treated without surgery. Although the PHVG was remained at follow up CT on the next day after the onset, the symptoms were improved. We selected conservative treatment without emergent surgery and he discharged on 9^th day after the onset. However, he was suffered from right lower abdominal pain and vomiting and admitted our hospital on 23th day. He developed ischemic intestinal stenosis and underwent a surgery of partial resection of ileum.

The clinical finding of this case showing subtle differences from cases who were successfully treated without surgery. We hope this report will help physician’s decision-making process for HPVG.

• Acute Physiology and Chronic Health Evaluation (APACHE) II score
• Case report
• Delayed elective surgery
• Hepatic portal vein gas

• Chronic bowel ischemia
• Comprehensive management
• Hepatic portal venous gas
• Limited operation

The significance of pneumatosis intestinalis (PI) and portal venous gas (PVG) is controversial. This retrospective study evaluated the risk factors for bowel necrosis in patients with PI and/or PVG.

Between 2002 and 2015, 52 patients were diagnosed with PI and/or PVG and were included in this study. The patients were classified according to the presence or absence of bowel necrosis in surgical findings or at autopsy. Patient characteristics and clinical findings related to bowel necrosis were investigated.

Bowel necrosis was diagnosed in 17 (32.7 %) patients. Amongst these 17, 10 patients received salvage surgical intervention, and seven of those diagnosed with bowel necrosis survived after the operation. The remaining 35 patients received conservative treatment with or without exploratory laparotomy. Between patients with and without bowel necrosis, laboratory data revealed significant differences in the levels of C-reactive protein (P = 0.0038), creatinine (P = 0.0054), and lactate (P = 0.045); clinical findings showed differences in abdominal pain (P = 0.019) and peritoneal irritation signs (P = 0.016); computed tomography detected ascites (P = 0.011) and changes of bowel wall enhancement (P = 0.03) that were significantly higher in patients with bowel necrosis. The rate of PI and/or PVG detected in patients postoperatively was significantly higher in patients with bowel necrosis (P < 0.0001). Multivariate analysis showed that bowel necrosis was significantly more likely when PI or PVG was detected in postoperative patients than in patients who had not had surgery (P = 0.003).

PI and/or PVG, alone, are not automatically indicative of bowel necrosis. However, when these conditions occur postoperatively, they indicate bowel necrosis requiring reoperation.

• Bowel necrosis
• Hepatic portal venous gas
• Pneumatosis intestinalis

Hepatic portal venous gas (HPVG) is a rare condition, with poor prognosis and a mortality rate of up to 75%. Indications for surgical and non-surgical management of HPVG including associated complications and mortality remain to be clarified.

From January 2008 to December 2014, 18 patients with HPVG diagnosed through abdominal computed tomography (CT) imaging were retrospectively identified. Clinical symptoms, laboratory data, underlying diseases, treatment, and mortality rate were analyzed. Patients were classified into 2 groups: surgical management recommended (SR, n=10) and conservative management (CM, n=8). The SR group was further subdivided into patients who underwent surgical management (SM-SR, n=5) and those who were managed conservatively (NS-SR, n=5).

Conditions underlying HPVG included mesenteric ischemia (38.9%), intestinal obstruction (22.2%), enteritis (22.2%), duodenal ulcer perforation (5.6%), necrotizing pancreatitis (5.6%), and diverticulitis (5.6%). In terms of mortality, 2 patients (40%) died in the SM-SR group, 1 (12.5%) in the CM group, and 100% in the NS-SR group. Higher scores from Acute Physiology and Chronic Health Evaluation (APACHE) II predicted the mortality rates of the NS-SR and CM groups.

Identification of HPVG requires careful consideration for surgical management. If surgical management is indicated, prompt laparotomy should be performed. However, even in the non-surgical management condition, aggressive laparotomy can improve survival rates for patients with high APACHE II scores.

• APACHE II
• Computed tomography
• Mesenteric ischemia
• Pneumatosis intestinalis
• Portal venous gas

• ER
• Emergency surgery
• gastroenterology and hepatology
• hepatic portal venous gas
• physical examination

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

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.

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.

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.