Author of 1 Presentation
SS 9.3 - Porto-mesenteric venous gas: is surgery still mandatory? (ID 684)
Abstract
Purpose
Porto-mesenteric venous gas (PMVG) is associated with mesenteric ischemia in 40-60% of cases with a high mortality rate requiring emergency surgery. Studies reported a decrease in the mortality rate with the identification on CT of non-ischemic underlying causes and unnecessary surgery. The aim of this study was to identify prognostic factors of mortality in patients with PMVG and to assess factors leading to unnecessary surgery in these patients.
Material and methods
88 patients with PMVG diagnosed by CT from January 2008 to December 2017 were retrospectively included. Clinical, biological and radiological findings were collected and their association with mortality and unnecessary surgery was assessed.
Results
The overall mortality rate was 45.5%. Etiologies of PMVG were bowel ischemia (42%), gastrointestinal (GIT) obstruction or dilatation (16%), post-abdominal surgery (14.7%), GIT infection or sepsis (8%), trauma (6.8%), unspecified (6.8%) and malignancy (5.7%). Mortality was significantly associated with bowel ischemia (p<0.001) and with radiological findings of bowel ischemia (lack of wall enhancement (p=0.005), pneumatosis intestinalis (p=0.001), arterial occlusion (p=0.021) and solid organ infarction (p=0.046)). In multivariate analysis, the absence of acidosis was the only sign associated with a reduction of mortality [OR=0.09; 95% CI: 0.02-0.52]. No independent factor was significantly associated with unnecessary surgery.
Conclusion
PMVG remains serious, especially when revealing bowel ischemia and when associated with acidosis. Unfortunately, no specific sign is associated with unnecessary surgery that can orientate the physician toward the decision or not of surgical management.