See the published version of this preprint at BMC Surgery.
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Research article
Manato Fujii
Ome Municipal General Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0353-6340
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Hepatic portal venous gas (HPVG) is a rare clinical condition that is caused by a variety of underlying diseases. However, the factors that would permit accurate identification of bowel ischemia, requiring surgery, in patients with HPVG have not been fully investigated.
Methods: Thirty patients that had been diagnosed with HPVG using computed tomography between 2010 and 2019 were allocated to two groups on the basis of clinical and intraoperative findings: those with (Group 1; n=12 [40%]) and without (Group 2; n=18 [60%]) bowel ischemia. Eleven patients underwent emergency surgery, and bowel ischemia was identified in eight of these (73%). Four patients in Group 1 were diagnosed with bowel ischemia, but treated palliatively because of their general condition. We compared the characteristics and outcomes of Groups 1 and 2 and identified possible prognostic factors for bowel ischemia.
Results: At admission, patients in Group 1 more commonly showed the peritoneal irritation sign, had lower base excess, higher lactate, and higher C-reactive protein, and more frequently had comorbid intestinal pneumatosis. Of the eight bowel ischemia surgery patients, four (50%) died, mainly because of anastomotic leak following bowel resection and primary anastomosis (3/4, 75%). All except one patient in Group 2, who presented with aspiration pneumonia, responded better to treatment.
Conclusions: Earlier identification and grading of bowel ischemia according to the findings at admission should benefit patients with HPVG by reducing the incidence of unnecessary surgery and increasing the use of safer procedures, such as prophylactic stoma placement.
Keywords
hepatic portal venous gas, bowel ischemia
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- supplefig1.tif
Supplementary Figure. 1 Receiver operating characteristic curves for the use of laboratory parameters measured at admission for the prediction of bowel ischemia The accuracy for the discrimination of patients with and without bowel ischemia was assessed by calculating the areas under the curves for base excess, lactate, and C-reactive protein on admission (A). Appropriate thresholds for the prediction of bowel ischemia were determined to be −5.5 mmol/L for base excess (B), 3.5 mmol/L for lactate (C), and 4.4 mg/dL for C-reactive protein (D). AUC, area under the curve; CI, confidence interval; SE, standard error. The P values indicate the usefulness of the parameter as a predictor (null hypothesis, AUC = 0.500).
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CURRENT STATUS: Published
View the published article at BMC Surgery.
Version 2
Posted 23 Sep, 2020
No community comments so far
Review #2 received
Received 10 Oct, 2020
Editorial decision: Major revision
On 10 Oct, 2020
Review #1 received
Received 08 Oct, 2020
Reviewer #2 agreed
On 01 Oct, 2020
Reviewer #1 agreed
On 27 Sep, 2020
Editor assigned
On 22 Sep, 2020
Reviewers invited
Invitations sent on 22 Sep, 2020
Submission checks complete
On 21 Sep, 2020
Editor invited
On 21 Sep, 2020
No comments provided
Editorial decision: Major revision
On 08 Sep, 2020
Review #2 received
Received 04 Sep, 2020
Review #1 received
Received 27 Aug, 2020
Reviewer #2 agreed
On 15 Aug, 2020
Reviewer #1 agreed
On 10 Aug, 2020
Editor assigned
On 08 Aug, 2020
Reviewers invited
Invitations sent on 08 Aug, 2020
Submission checks complete
On 06 Aug, 2020
Editor invited
On 06 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Gastrointestinal Surgery
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See the published version of this preprint at BMC Surgery.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Manato Fujii
Ome Municipal General Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0353-6340
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Surgery.
Version 2
Posted 23 Sep, 2020
No community comments so far
Review #2 received
Received 10 Oct, 2020
Editorial decision: Major revision
On 10 Oct, 2020
Review #1 received
Received 08 Oct, 2020
Reviewer #2 agreed
On 01 Oct, 2020
Reviewer #1 agreed
On 27 Sep, 2020
Editor assigned
On 22 Sep, 2020
Reviewers invited
Invitations sent on 22 Sep, 2020
Submission checks complete
On 21 Sep, 2020
Editor invited
On 21 Sep, 2020
No comments provided
Editorial decision: Major revision
On 08 Sep, 2020
Review #2 received
Received 04 Sep, 2020
Review #1 received
Received 27 Aug, 2020
Reviewer #2 agreed
On 15 Aug, 2020
Reviewer #1 agreed
On 10 Aug, 2020
Editor assigned
On 08 Aug, 2020
Reviewers invited
Invitations sent on 08 Aug, 2020
Submission checks complete
On 06 Aug, 2020
Editor invited
On 06 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Gastrointestinal Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Surgery.
Background: Hepatic portal venous gas (HPVG) is a rare clinical condition that is caused by a variety of underlying diseases. However, the factors that would permit accurate identification of bowel ischemia, requiring surgery, in patients with HPVG have not been fully investigated.
Methods: Thirty patients that had been diagnosed with HPVG using computed tomography between 2010 and 2019 were allocated to two groups on the basis of clinical and intraoperative findings: those with (Group 1; n=12 [40%]) and without (Group 2; n=18 [60%]) bowel ischemia. Eleven patients underwent emergency surgery, and bowel ischemia was identified in eight of these (73%). Four patients in Group 1 were diagnosed with bowel ischemia, but treated palliatively because of their general condition. We compared the characteristics and outcomes of Groups 1 and 2 and identified possible prognostic factors for bowel ischemia.
Results: At admission, patients in Group 1 more commonly showed the peritoneal irritation sign, had lower base excess, higher lactate, and higher C-reactive protein, and more frequently had comorbid intestinal pneumatosis. Of the eight bowel ischemia surgery patients, four (50%) died, mainly because of anastomotic leak following bowel resection and primary anastomosis (3/4, 75%). All except one patient in Group 2, who presented with aspiration pneumonia, responded better to treatment.
Conclusions: Earlier identification and grading of bowel ischemia according to the findings at admission should benefit patients with HPVG by reducing the incidence of unnecessary surgery and increasing the use of safer procedures, such as prophylactic stoma placement.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- supplefig1.tif
Supplementary Figure. 1 Receiver operating characteristic curves for the use of laboratory parameters measured at admission for the prediction of bowel ischemia The accuracy for the discrimination of patients with and without bowel ischemia was assessed by calculating the areas under the curves for base excess, lactate, and C-reactive protein on admission (A). Appropriate thresholds for the prediction of bowel ischemia were determined to be −5.5 mmol/L for base excess (B), 3.5 mmol/L for lactate (C), and 4.4 mg/dL for C-reactive protein (D). AUC, area under the curve; CI, confidence interval; SE, standard error. The P values indicate the usefulness of the parameter as a predictor (null hypothesis, AUC = 0.500).
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