Journal article
Management Algorithm for Pneumatosis Intestinalis and Portal Venous Gas: Treatment and Outcome of 88 Consecutive Cases
Journal of gastrointestinal surgery, Vol.14(3), pp.437-448
03/2010
DOI: 10.1007/s11605-009-1143-9
PMID: 20077158
Abstract
Pneumatosis intestinalis (PI) and portal venous gas (PVG) historically mandated laparotomy due to the high mortality rate associated with mesenteric ischemia. Computed tomography (CT) can identify PI/PVG in patients with ischemic emergencies and benign idiopathic conditions.A consecutive series of patients with PI or PVG was reviewed from a single institution over 5 years. Eighty-eight cases of PI/PVG were studied: 74 initial patients (year 1–4) were used to generate a treatment algorithm and fourteen additional cases were used to test the algorithm.PI and PVG were associated with three major clinical subgroups: mechanical causes (n = 29), acute mesenteric ischemia (n = 29), and benign idiopathic (n = 26); four were unclassifiable. Patients with acute mesenteric ischemia were associated with abdominal pain (p = 0.01), elevated lactate (≥3.0 mg/dL; p = 0.006), small bowel PI (p = 0.04), and calculated vascular disease score (p < 0.0005). The three subgroups could be distinguished using the generated algorithm with a sensitivity of 89%, specificity of 100%, and positive predictive value of 100%.With greater sensitivity of modern CT scans, PI and PVG are being detected in patients with a wide range of surgical and non-surgical conditions. This clinical algorithm can identify subgroups to direct surgical intervention for acute ischemic insults and prevent non-therapeutic laparotomies for benign idiopathic PI and PVG.
Details
- Title: Subtitle
- Management Algorithm for Pneumatosis Intestinalis and Portal Venous Gas: Treatment and Outcome of 88 Consecutive Cases
- Creators
- Erik Wayne - Department of Surgery University of Louisville 550 S. Jackson St. Louisville KY 40202 USAMatthew Ough - Department of Surgery Rush University Medical Center 1653 W. Congress Parkway Chicago IL 60612 USAAndrew Wu - Department of Radiology University of Iowa Hospitals and Clinics 200 Hawkins Dr. Iowa City IA 52242 USAJunlin Liao - Department of Surgery University of Iowa Hospitals and Clinics 200 Hawkins Drive Iowa City IA 52242 USAK Andresen - Department of Radiology University of Iowa Hospitals and Clinics 200 Hawkins Dr. Iowa City IA 52242 USADavid Kuehn - Department of Radiology University of Iowa Hospitals and Clinics 200 Hawkins Dr. Iowa City IA 52242 USANeal Wilkinson - Department of Surgery University of Iowa Hospitals and Clinics 200 Hawkins Drive Iowa City IA 52242 USA
- Resource Type
- Journal article
- Publication Details
- Journal of gastrointestinal surgery, Vol.14(3), pp.437-448
- Publisher
- Springer-Verlag; New York
- DOI
- 10.1007/s11605-009-1143-9
- PMID
- 20077158
- ISSN
- 1091-255X
- eISSN
- 1873-4626
- Language
- English
- Date published
- 03/2010
- Academic Unit
- Radiology; Surgery; Urology
- Record Identifier
- 9984051545402771
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