He Chanchan, Zhang Junqiang, Yuan Bo, Pang Yan
Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou, China.
Ann Med. 2024 Dec;56(1):2389293. doi: 10.1080/07853890.2024.2389293. Epub 2024 Aug 8.
Hepatic portal venous gas(HPVG) represents a rare radiographic phenomenon frequently linked to intestinal necrosis, historically deemed to need immediate surgical intervention. The pivotal query arises about the imperative of urgent surgery when a patient manifests HPVG after gastrointestinal surgery. This inquiry seeks to elucidate whether emergent surgical measures remain a requisite in such cases.
The investigation into 14 cases of HPVG after gastrointestinal procedures was conducted through a comprehensive review of relevant literature. This methodological approach contributes to a nuanced understanding of HPVG occurrences following gastrointestinal surgery, informing clinical considerations and potential therapeutic strategies.
Among the 14 patients, 12 recovered and 2 died. 6 patients underwent surgical exploration, 4 with negative findings and recovered. 8 cases received conservative treatment, resulting in improvement for 5, and 1 initially treated conservatively, revealed perforation during later surgical exploration, leading to improvement, 1 case ended in mortality.
After gastrointestinal surgery, in Computed Tomography (CT) imaging, the coexistence of HPVG and gastrointestinal dilatation, without signs of peritoneal irritation on abdominal examination, may suggest HPVG due to acute gastrointestinal injury, intestinal gas, and displacement of gas-producing bacteria. These patients can be managed conservatively under close supervision. In cases where HPVG coexists with gastrointestinal dilatation and Pneumatosis intestinalis (PI) without signs of peritoneal irritation, conservative treatment may be continued under close supervision. However, if progressive exacerbation occurs despite close monitoring and the aforementioned treatments, timely surgical exploration is deemed necessary. When HPVG is combined with signs of peritoneal irritation, prompt laparotomy and exploration are preferred.
肝门静脉积气（HPVG）是一种罕见的影像学现象，常与肠坏死相关，历来被认为需要立即进行手术干预。当患者在胃肠道手术后出现HPVG时，紧急手术的必要性就成为了关键问题。本研究旨在阐明在此类情况下紧急手术措施是否仍然必要。
通过全面回顾相关文献，对14例胃肠道手术后出现HPVG的病例进行了调查。这种方法有助于对胃肠道手术后HPVG的发生有更细致的了解，为临床考虑和潜在的治疗策略提供依据。
14例患者中，12例康复，2例死亡。6例患者接受了手术探查，4例结果为阴性并康复。8例接受保守治疗，5例病情改善，1例最初接受保守治疗，后来手术探查发现穿孔，病情改善，1例死亡。
胃肠道手术后，在计算机断层扫描（CT）成像中，HPVG与胃肠道扩张并存，腹部检查无腹膜刺激征，可能提示HPVG是由急性胃肠道损伤、肠内气体和产气细菌移位引起的。这些患者可在密切监测下进行保守治疗。在HPVG与胃肠道扩张和肠壁积气（PI）并存且无腹膜刺激征的情况下，可在密切监测下继续保守治疗。然而，如果尽管密切监测和采取上述治疗仍出现病情进行性加重，则认为有必要及时进行手术探查。当HPVG伴有腹膜刺激征时，首选及时剖腹探查。
