Abstract
Hepatic portal venous gas (HPVG) has been considered an ominous radiologic sign. However, the increased use of high resolution CT has allowed early and highly sensitive detection of not only bowel necrosis, but also non-life-threatening causes of HPVG. Because the prognosis is related to the pathology itself and is not influenced by the presence of HPVG, appropriate treatment depends on the underlying disease. However, it is sometimes difficult to exclude bowel necrosis before deciding whether to perform exploratory laparotomy. To establish the appropriate management of HPVG, we retrospectively reviewed the records of patients seen in our institution from April 2009 to March 2013. Twelve cases of HPVG were detected and 8 cases were excluded because of cardiopulmonary arrest. Four cases showed bowel necrosis, which achieved significance with signs of rebound tenderness (p=0.039), base excess (p=0.039), and C-reactive protein (p=0.025). Neither the findings of HPVG nor the amount of HPVG significantly relate to bowel necrosis. In conclusion, signs of rebound tenderness, base excess, and C-reactive protein were important indicators of bowel necrosis in our study.
