Identification of CT features and laboratory indicators to aid in the management of patients with portal venous gas identified on imaging.

Abstract

Background: It can be difficult to distinguish cases of benign portal venous gas (PVG) that can be managed conservatively from forms associated with ischaemic bowel.

Purpose: To identify CT, clinical and laboratory factors that may be assist in the decision-making regarding patient management.

Methods: All patients in whom PVG was demonstrated on CT imaging were identified over an 8-year period. CT imaging was reviewed for 19 CT features. Clinical findings and laboratory values also retrospectively reviewed. Patients were divided into four groups based on management and outcomes; Group 1, conservatively managed and died, Group 2, conservatively managed and survived, Group 3, operative management and died and Group 4, operative managed and survived.

Results: Fifty-six patients had PVG. Overall mortality rate was 54%. Thirty-four percent of patients underwent surgical exploration. Sixty-six percent of patients were managed conservatively. Serum lactate values were found to be highest in Group 1 and lowest in Group 2 (p < 0.001). Neutrophil/lymphocyte ratios significantly differed across the groups. High serum lactate was associated with significantly increased inpatient hospital mortality. CT features of a stenosed or occluded coeliac artery, stenosed or occluded superior mesenteric artery, bowel obstruction, non-obstructed small bowel dilatation and the presence of ascites were associated with significantly increased inpatient hospital mortality.

Conclusion: Management of patients with PVG should be determined by assessing the combination of clinical assessment, laboratory values in addition to CT features. Attention may be given to elevated serum lactate levels and specific CT features associated with higher mortality rates.