title: Clinical outcomes in surgical and non-surgical management of hepatic portal venous gas.
abstract: OBJECTIVE
  Hepatic portal venous gas (HPVG) is a rare condition, with poor prognosis and a mortality rate of up to 75%. Indications for surgical and non-surgical management of HPVG including associated complications and mortality remain to be clarified.
  
  
  METHODS
  From January 2008 to December 2014, 18 patients with HPVG diagnosed through abdominal computed tomography (CT) imaging were retrospectively identified. Clinical symptoms, laboratory data, underlying diseases, treatment, and mortality rate were analyzed. Patients were classified into 2 groups: surgical management recommended (SR, n=10) and conservative management (CM, n=8). The SR group was further subdivided into patients who underwent surgical management (SM-SR, n=5) and those who were managed conservatively (NS-SR, n=5).
  
  
  RESULTS
  Conditions underlying HPVG included mesenteric ischemia (38.9%), intestinal obstruction (22.2%), enteritis (22.2%), duodenal ulcer perforation (5.6%), necrotizing pancreatitis (5.6%), and diverticulitis (5.6%). In terms of mortality, 2 patients (40%) died in the SM-SR group, 1 (12.5%) in the CM group, and 100% in the NS-SR group. Higher scores from Acute Physiology and Chronic Health Evaluation (APACHE) II predicted the mortality rates of the NS-SR and CM groups.
  
  
  CONCLUSIONS
  Identification of HPVG requires careful consideration for surgical management. If surgical management is indicated, prompt laparotomy should be performed. However, even in the non-surgical management condition, aggressive laparotomy can improve survival rates for patients with high APACHE II scores.
authors.affiliation: Department of Surgery, Daegu Fatima Hospital, Daegu, Korea.
authors.forename: Soo-Kyung
authors.initials: SK
authors.lastname: Yoo
authors.affiliation: Department of Surgery, Daegu Fatima Hospital, Daegu, Korea.
authors.forename: Jong-Hoon
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Surgery, Daegu Fatima Hospital, Daegu, Korea.
authors.forename: Sang Hwy
authors.initials: SH
authors.lastname: Kwon
keywords: APACHE II; Computed tomography; Mesenteric ischemia; Pneumatosis intestinalis; Portal venous gas