title: Risk factors for bowel necrosis in patients with hepatic portal venous gas.
abstract: OBJECTIVE
  To evaluate the risk factors for bowel necrosis in adult patients with hepatic portal venous gas (HPVG).
  
  
  METHODS
  This retrospective study comprised 33 adult patients treated for HPVG between August, 2008 and December, 2011. The patients were divided into a necrotic group (n = 14) and a non-necrotic group (n = 19). We analyzed the clinical demographics, laboratory data, multi-detector computed tomography findings, treatments, and outcomes in each group.
  
  
  RESULTS
  Abdominal pain, peritoneal signs, systolic blood pressure, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase (LDH), small intestinal dilatation, poor enhancement of the bowel wall, and intestinal pneumatosis were all significantly associated with bowel necrosis. Moreover, there were significantly more operative cases and deaths in the necrotic group. Multivariate analysis revealed that systolic BP (p = 0.048), LDH (p = 0.022), and intestinal pneumatosis (p = 0.038) were independent risk factors for bowel necrosis. Thus, we created new diagnostic criteria for bowel necrosis based on these three factors, the sensitivity, specificity, and accuracy of which were 100, 78.9, and 87.9 %, respectively.
  
  
  CONCLUSIONS
  This study demonstrates new and important findings to evaluate the risk factors for bowel necrosis. Using our diagnostic criteria, the indications for emergency laparotomy can be established more accurately.
authors.affiliation: Department of Surgery, Center for Gastroenterology, Urasoe General Hospital, Iso 4-16-1, Urasoe, 901-2132, Japan, amicopter@gmail.com.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koami
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Isa
authors.forename: Tomonari
authors.initials: T
authors.lastname: Ishimine
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Kameyama
authors.forename: Toshinobu
authors.initials: T
authors.lastname: Matsumura
authors.forename: Kosuke Chris
authors.initials: KC
authors.lastname: Yamada
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005740:Gases / Q000097:blood*; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology* / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009336:Necrosis; D011006:Pneumatosis Cystoides Intestinalis; D011169:Portal Vein / Q000000981:diagnostic imaging; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D005740:Gases