Abstract
We examined retrospectively 34 patients with hepatic portal venous gas experienced in our department to elucidate useful indications of surgery for hepatic portal venous gas. We divided these patients into two groups ; Group A (15 patients, treated conservatively) and Group B (19 patients, indicated surgery). We compared these two groups. The cases of shock state and those with positive peritoneal irritation sign were all involved in the Group B but not in the Group A, showing a significant difference. There were significant differences in base excess and creatine kinase between the two groups. As for the SIRS diagnostic criteria, there was significant differences in the number of positive items and pulse rate between two groups. As to CT findings, ascites, free air, pneumatosis intestinalis and expansion of the portal venous gas were examined, and no significant difference were noted. Therefore, emergency surgery was considered to be absolutely required for the shock and/or peritoneal irritation sign positive cases with hepatic portal venous gas. We also conclude that surgery should be considered for the SIRS case with tachycardia, but we cannot decide surgical indication from the quantity and expansion of the portal venous gas on CT.
