Surgical Indication of Hepatic Portal Venous Gas -Our Experiences of 12 Cases-

Hitoshi Kanamaru, Hidetarou Yokoyama, Motoaki Shirakawa, Harumitsu Hashimoto, Goro Yoshino, Akira Takatsu, Ko Sugiyama^* and Toshikazu Akiyama^*

Department of Surgery, Department of Ultrasound^*, Fujieda Municipal General Hospital

While hepatic portal venous gas (HPVG) is considered a poor prognostic condition requiring emergency laparotomy, many cases have been reported to recover spontaneously without surgical intervention, making surgical indication controversial. We report 12 cases of HPVG, focusing on indications for emergency laparotomy. Materials and Methods: We clinically compared 2 groups, -5 patients with intestinal necrosis (group A), 7 without (group B). Results: All group A patients were in poor general condition with abdominal rigidity, while group B patients had good general condition with abdominal muscle guarding in only 1 case. All group A patients had fever, while 4 in group B were fever-free. White blood cell counts (WBC) exceeded 10,000/mm³ in 5 group A patients, and in 5 group B. C-reactive protein (CRP) exceeded 20mg/dl in 2 of the group A patients with 4.3mg/dl and 7.0mg/dl in other 2 patients, but was less than 1.1mg/dl in 5 group B patients. Conclusions: Two mechanisms underly HPVG production; gas-producing bacteria such as E. coli, in intestinal necrosis and elevated intestinal pressure in, e.g., nonstrangulated intestinal obstruction. Laparotomy is not assumed necessary in cases of elevated intestinal pressure. Surgical indications for HPVG depend on the existence of intestinal necrosis, determined by clinical signs including general condition, abdominal status, body temperature, etc. Physical examination is as important as in other acute abdomen disorders. In laboratory data, CRP is more helpful than WBC in deciding surgical indications.

Key words
portal hepatic venous gas, surgical indication, gas producing bacteria, CRP

Reprint requests
Hitoshi Kanamaru Fujieda Municipal General Hospital 4-1-11 Surugadai, Fujieda, 426-8677 JAPAN

Accepted
May 1, 2002

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