PS02.152: DEVELOPMENT OF INTESTINAL PNEUMATOSIS AND PORTAL VENOUS GAS AFTER ESOPHAGECTOMY IS NOT INDICATIVE OF ISCHEMIC BOWEL AND CAN BE SUCCESSFULLY MANAGED NON-OPERATIVELY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 164-164
Author(s):  
Erin Gillaspie ◽  
Micheal Moynagh ◽  
Sameh Said ◽  
Mark Allen ◽  
Shanda Blackmon ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Case Series ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Tube Placement ◽  
Jejunostomy Tube ◽  
Radiographic Findings ◽  
Intestinal Pneumatosis ◽  
Ischemic Bowel ◽  
Portal Venous Gas

Abstract Background Pneumatosis intestinalis has long been a marker of advanced bowel ischemia and prompts urgent laparotomy. In post-operative settings, the presence of pneumatosis represents a significant management dilemma. We share a case-series of post-esophagectomy patients with pneumatosis intestinalis and no corollary intra-abdominal pathologic findings on re-exploration. Methods January 2000 to December 2017, 1760 patients underwent Ivor-Lewis esophagectomy or gastrectomy with jejunostomy-tube placement. Charts were reviewed retrospectively to identify patients with pneumatosis intestinalis discovered in the post-operative period. Demographic data, operative details and postoperative course were reviewed including incidence and details of re-exploration. Results Eleven patients met inclusion criteria. Nine were male (81.8%) and mean age was 69 years. All patients had radiographic confirmation of pneumatosis intestinalis and in many cases portal venous gas (Figure 1). Clinical course was variable without discernable trends in vitals or laboratory values. Development of significant postoperative ileus along with delivery of enteral tube feeds through a jejunostomy tube preceded development of the pneumatosis in all patients. Nine patients were re-explored and none had evidence of bowel ischemia. Conclusion The finding of pneumatosis intestinalis in the post-operative setting can be alarming and pose a management dilemma. With the advent of improved and readily available imaging, there has been an increase in findings that have no corollary physical symptomatology. In this series of patients, despite dramatic radiographic findings, none had ischemic bowel. Pneumatosis intestinalis alone in patients who have undergone esophagectomy should not be considered an indication for emergency re-exploration. Disclosure All authors have declared no conflicts of interest.

scholarly journals A rare case of portal pneumatosis. What are the therapeutic resources?

2019 ◽  
Vol 2 (1) ◽  
pp. 15-16
Author(s):  
IULIAN SLAVU ◽  
Daniela Mihaila ◽  
Lucian Alecu
Keyword(s):  
Decompression Sickness ◽  
Stable Condition ◽  
Pneumatosis Intestinalis ◽  
Clinical State ◽  
Hepatic Portal Venous Gas ◽  
Severe Condition ◽  
Gastric Distention ◽  
Ischemic Bowel ◽  
Portal Venous Gas ◽  
Hepatic Portal

Hepatic portal vein gas was first describes in 1955 by Wolf and Evans. It is a rare and severe condition that in 80% of cases leads to patient’s death. Most common causes are :necrotizing enterocolitis, mesenteric ischemia, sepsis , intestinal perforation. A 73-year old male patient underwent an elective rectal amputation for anal adenocarcinoma, after radiotherapy.In the 12th postoperative day the clinical state of the patient degraded, with onset of acute abdominal pain and fever.A CT scan and ultrasound examination showed the presence of  hepatic portal venous gas with of pneumatosis intestinalis and an abcess in the pelvic region.Intraoperatively, two small perforations were found at the distal jejunun with no ischemia or necrosis. An ileostomy was performed, with drainage of the peritoneal cavity.Post-operatively the patient was stabilized and was eventually discharged in stable condition .The presence of hepatic portal venous gas with the  of pneumatosis intestinalis is most frequently associated with ischemic bowel, ileus, diverticulitis, gastric distention, inflammatory bowel disease (IBD), hypotension post dialysis treatment, decompression sickness, trauma and iatrogenic causes from instrumentation and recent surgery.

Extensive Portal Venous Gas and Pneumatosis Intestinalis in the Absence of Small Bowel Ischemia or Infarction

2007 ◽  
Vol 102 ◽  
pp. S373-S374
Author(s):  
Pavan K. Pinnamaneni ◽  
Parupudi V.J. Sriram ◽  
David Hodges ◽  
Ari Halldorsson
Keyword(s):  
Small Bowel ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Portal Venous Gas

scholarly journals Laparoscopic Jejunostomy as the standard procedure of Jejunostomy tube placement in upper GI and laryngeal cancers: A case series

2021 ◽  
Keyword(s):  
Standard Procedure ◽  
Pancreatic Enzyme ◽  
Case Series ◽  
Tube Placement ◽  
Jejunostomy Tube ◽  
Upper Gi ◽  
Increased Risk ◽  
Catheter Obstruction ◽  
Laparoscopic Jejunostomy

Background: Laparoscopic enteral-feeding access is the best option for patients with advanced upper gastrointestinal, oropharyngeal, and laryngeal cancers needing to maintain their caloric intake before surgery or during chemoradiotherapy. Methods: During a laparoscopic procedure by a cystostomy catheter system, a jejunostomy tube was placed for 14 patients. All the patients had a 2-month follow-up for complications and performance of the feeding system. Results: Based on the obtained results, there was no internal leak and peritonitis among the subjects. One patient converted to an open procedure due to perforation during the procedure. In three patients, the extraction of the catheter was encountered during the follow-up period and a replacement was required. One case of wound infection and one case of catheter obstruction occurred among the subjects. Catheter obstruction was easily resolved using warm water and pancreatic enzyme irrigation. There was one patient with partial intestinal obstruction who was managed through nonoperative means. No significant bleeding was encountered during the surgery. Conclusion: Laparoscopic jejunostomy with this method is simple and cost-effective and can be performed within an acceptable timeframe with minimum complications. It is the procedure of choice for upper GI and laryngeal cancer patients, those at increased risk of aspiration, and subjects not candidates of percutaneous endoscopic gastrostomy. Reference

scholarly journals Clinical features of patients with hepatic portal venous gas

2020 ◽  
Author(s):  
Manato Fujii ◽  
Suguru Yamashita ◽  
Mayuko Tanaka ◽  
Jo Tashiro ◽  
Yoshiharu Takenaka ◽  
...  
Keyword(s):  
Primary Anastomosis ◽  
Bowel Ischemia ◽  
Hepatic Portal Venous Gas ◽  
Accurate Identification ◽  
Intestinal Pneumatosis ◽  
Reactive Protein ◽  
Portal Venous Gas ◽  
Group 2 ◽  
Hepatic Portal ◽  
Group 1

Abstract Background: Hepatic portal venous gas (HPVG) is a rare clinical condition that is caused by a variety of underlying diseases. However, the factors that would permit accurate identification of bowel ischemia, requiring surgery, in patients with HPVG have not been fully investigated.Methods: Thirty patients that had been diagnosed with HPVG using computed tomography between 2010 and 2019 were allocated to two groups on the basis of clinical and intraoperative findings: those with (Group 1; n = 12 [40%]) and without (Group 2; n = 18 [60%]) bowel ischemia. Eleven patients underwent emergency surgery, and bowel ischemia was identified in eight of these (73%). Four patients in Group 1 were diagnosed with bowel ischemia, but treated palliatively because of their general condition. We compared the characteristics and outcomes of Groups 1 and 2 and identified possible prognostic factors for bowel ischemia.Results: At admission, patients in Group 1 more commonly showed the peritoneal irritation sign, had lower base excess, higher lactate, and higher C-reactive protein, and more frequently had comorbid intestinal pneumatosis. Of the eight bowel ischemia surgery patients, four (50%) died, mainly because of anastomotic leak following bowel resection and primary anastomosis (3/4, 75%). All except one patient in Group 2, who presented with aspiration pneumonia, responded better to treatment.Conclusions: Earlier identification and grading of bowel ischemia according to the findings at admission should benefit patients with HPVG by reducing the incidence of unnecessary surgery and increasing the use of safer procedures, such as prophylactic stoma placement.

scholarly journals Clinical features of patients with hepatic portal venous gas

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Manato Fujii ◽  
Suguru Yamashita ◽  
Mayuko Tanaka ◽  
Jo Tashiro ◽  
Yoshiharu Takenaka ◽  
...  
Keyword(s):  
Primary Anastomosis ◽  
Bowel Ischemia ◽  
Hepatic Portal Venous Gas ◽  
Accurate Identification ◽  
Intestinal Pneumatosis ◽  
Reactive Protein ◽  
Portal Venous Gas ◽  
Group 2 ◽  
Hepatic Portal ◽  
Group 1

Abstract Background Hepatic portal venous gas (HPVG) is a rare clinical condition that is caused by a variety of underlying diseases. However, the factors that would permit accurate identification of bowel ischemia, requiring surgery, in patients with HPVG have not been fully investigated. Methods Thirty patients that had been diagnosed with HPVG using computed tomography between 2010 and 2019 were allocated to two groups on the basis of clinical and intraoperative findings: those with (Group 1; n = 12 [40%]) and without (Group 2; n = 18 [60%]) bowel ischemia. Eleven patients underwent emergency surgery, and bowel ischemia was identified in eight of these (73%). Four patients in Group 1 were diagnosed with bowel ischemia, but treated palliatively because of their general condition. We compared the characteristics and outcomes of Groups 1 and 2 and identified possible prognostic factors for bowel ischemia. Results At admission, patients in Group 1 more commonly showed the peritoneal irritation sign, had lower base excess, higher lactate, and higher C-reactive protein, and more frequently had comorbid intestinal pneumatosis. Of the eight bowel ischemia surgery patients, four (50%) died, mainly because of anastomotic leak following bowel resection and primary anastomosis (3/4, 75%). All except one patient in Group 2, who presented with aspiration pneumonia, responded better to treatment. Conclusions Earlier identification and grading of bowel ischemia according to the findings at admission should benefit patients with HPVG by reducing the incidence of unnecessary surgery and increasing the use of safer procedures, such as prophylactic stoma placement.

scholarly journals Clinical features of patients with hepatic portal venous gas

2020 ◽  
Author(s):  
Manato Fujii ◽  
Suguru Yamashita ◽  
Mayuko Tanaka ◽  
Jo Tashiro ◽  
Yoshiharu Takenaka ◽  
...  
Keyword(s):  
Primary Anastomosis ◽  
Bowel Ischemia ◽  
Hepatic Portal Venous Gas ◽  
Accurate Identification ◽  
Intestinal Pneumatosis ◽  
Reactive Protein ◽  
Portal Venous Gas ◽  
Group 2 ◽  
Hepatic Portal ◽  
Group 1

Abstract Background: Hepatic portal venous gas (HPVG) is a rare clinical condition that is caused by a variety of underlying diseases. However, the factors that would permit accurate identification of bowel ischemia, requiring surgery, in patients with HPVG have not been fully investigated.Methods: Thirty patients that had been diagnosed with HPVG using computed tomography between 2010 and 2019 were allocated to two groups on the basis of clinical and intraoperative findings: those with (Group 1; n=12 [40%]) and without (Group 2; n=18 [60%]) bowel ischemia. Eleven patients underwent emergency surgery, and bowel ischemia was identified in eight of these (73%). Four patients in Group 1 were diagnosed with bowel ischemia, but treated palliatively because of their general condition. We compared the characteristics and outcomes of Groups 1 and 2 and identified possible prognostic factors for bowel ischemia.Results: At admission, patients in Group 1 more commonly showed the peritoneal irritation sign, had lower base excess, higher lactate, and higher C-reactive protein, and more frequently had comorbid intestinal pneumatosis. Of the eight bowel ischemia surgery patients, four (50%) died, mainly because of anastomotic leak following bowel resection and primary anastomosis (3/4, 75%). All except one patient in Group 2, who presented with aspiration pneumonia, responded better to treatment.Conclusions: Earlier identification and grading of bowel ischemia according to the findings at admission should benefit patients with HPVG by reducing the incidence of unnecessary surgery and increasing the use of safer procedures, such as prophylactic stoma placement.

scholarly journals Portomesenteric Venous System Gas after CT Colonography: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Ilaria Sansoni ◽  
Claudia Lucia Piccolo ◽  
Ilenia Di Giampietro ◽  
Matteo Polacco ◽  
Bruno Beomonte Zobel
Keyword(s):  
Ct Scan ◽  
Ct Colonography ◽  
Pneumatosis Intestinalis ◽  
Clinical Findings ◽  
Bowel Ischemia ◽  
Colonic Perforation ◽  
Venous System ◽  
Portal Venous System ◽  
Portal Venous Gas ◽  
Mucosal Integrity

Portomesenteric vein gas can occur owing to a variety of interraleted factors such as loss of mucosal integrity and intraluminal overpressure, and the most common and serious cause is bowel ischemia, which requires urgent laparotomy. Nevertheless, when portal venous gas is caused by nonischemic causes, surgery is not required and it can be treated conservatively. So, its features should be carefully evaluated at CT scan, together with clinical findings. The authors report a case of an old male with portomesenteric venous system gas after CT colonography, without evidence of pneumatosis intestinalis or colonic perforation. A CT scan without enema was required after 24 hours in absence of worsened patient conditions, revealing the disappearance of gas in mesenteric vein and in the portal venous system.

Pneumatosis Intestinalis and Portal Venous Gas Without Bowel Ischemia in a Patient Treated with Irinotecan and Cisplatin

2007 ◽  
Vol 53 (1) ◽  
pp. 217-219 ◽  
Author(s):  
David Kung ◽  
Daniel T Ruan ◽  
Rodney K. Chan ◽  
Melissa L. Ericsson ◽  
Mandeep S. Saund
Keyword(s):  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Portal Venous Gas

scholarly journals Association of Contrast-Enhanced CT Findings with Etiology and Outcome in Patients with Portal Venous Gas and Pneumatosis Intestinalis: A Single Center Case Series Study

2021 ◽  
Author(s):  
Naohiro Yoshida ◽  
Yoshihiko Sadakari ◽  
Kazuhito Tamehiro ◽  
Kazuma Ohkawara ◽  
Hiroyuki Nakane ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Portal Venous Gas ◽  
Ct Findings ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
The Relationship ◽  
Group 1

Abstract Background: Contrast-enhanced computed tomography (CT) is a reliable diagnostic tool often used to investigate the etiology of portal venous gas (PVG) and pneumatosis intestinalis (PI). However, there are few reports that offer an analysis of the relationship between particular CT findings and clinical outcomes. In this paper, we sought to close that gap and present the results of our analyses that reveal which CT findings are correlated with life-threatening cases.Methods: 39 patients were diagnosed with PVG or PI from contrast-enhanced CT scans and underwent treatment at St. Mary’s Hospital from January 2009 to December 2018. We reviewed patients’ medical charts, laboratory data, and CT scan images retrospectively. We defined cases resulting in operation or death as group 1, and patients with conservative treatment who survived as group 2. We then analyzed the relationship between each CT finding and clinical feature.Results: The primary underlying diseases identified for PVG and PI were bowel ischemia (13/39), enteritis (9/39), constipation (5/39), iatrogenic disease (4/39), and hemodialysis (3/39). Poor enhancement of the intestinal wall and extrahepatic venous gas were correlated with bowel ischemia (p=0.0002 and p=0.0003, respectively). Free air was less correlated with bowel ischemia (p=0.02). Wall thickness was correlated with enteritis (p=0.02). Mortality in cases with bowel ischemia and perforation was quite high (60%) even if patients underwent surgery (33.3%). Conversely, patients with enteritis, constipation, hemodialysis and gastric dilatation who did not require surgery resulted in more favorable outcomes with conservative treatment. In the multivariate analysis, extra hepatic venous gas was the only solitary factor correlated with group 1 (p=0.0008).Conclusions: Extra hepatic venous gas was the strongest predictive factor of clinical outcome in contrast-enhanced CT findings correlated with bowel ischemia and required surgical treatment. The other CT findings were useful in diagnosing the underlying disease, but were not correlated with clinical outcomes. The necessity for surgical treatment remains dependent on the root cause.

Pneumatosis Intestinalis after Open Jejunostomy Tube Placement

2013 ◽  
Vol 79 (2) ◽  
pp. 73-75 ◽  
Author(s):  
Craig Selander ◽  
Rana Pullatt ◽  
Nestor Esnaola ◽  
E. Ramsay Camp
Keyword(s):  
Pneumatosis Intestinalis ◽  
Tube Placement ◽  
Jejunostomy Tube
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