Research progress on etiology and mechanism of portal vein gas / 中华肝胆外科杂志

Portal vein gas (PVG) is a kind of imaging sign which has been attracting widespread attention in recent years, and its appearance is often accompanied by serious or fatal situation. PVG is not an indication of surgery and the treatments depend on potential diseases. When there are serious potential abdominal diseases, the emergency surgical intervention will be needed. The potential diseases that cause PVG mainly include infectious, ischemic, mechanical and medical. The prognosis is not related with PVG, but is affected by the pathogenesis. Although more and more reports about PVG have been reported in recent years, the research on its pathogenesis is less. Based on the review of the previous literatures, the pathogenesis, risk factors, imaging manifestations, treatment and prognosis of PVG were discussed.

Necrotizing enteritis with portal vein gas and pneumatosis cystoides intestinalis treated with delayed operation / 영남의대학술지

Portal vein gas and pneumatosis cystoides intestinalis are uncommon conditions and have been associated with poor prognosis. They are most commonly caused by necrotizing enterocolitis but may have other causes, and they can be associated with necrotizing and ischemic colitis, intra-abdominal abscess, small bowel obstruction, diverticulitis, colon cancer, and acute pancreatitis. With the more frequent use of computed tomography (CT) scans, portal vein gas and pneumatosis cystoides intestinalis have been increasingly detected in recent years. Because of its high mortality rate, necrotizing enteritis with portal vein gas and pneumatosis cystoides intestinalis may be treated with emergent exploratory laparotomy. We report a case of necrotizing enteritis with portal vein gas and pneumatosis cystoides intestinalis in a 47-year-old man treated with intensive medical management and delayed operation due to unstable condition and surgical mortality. He had good clinical results without complications after the delayed operation.

Prognosis and Predictive Factors according to Extent of Involvement in Necrotizing Enterocolitis among Very Low Birth Weight Infants

PURPOSE: This study aimed to evaluate the prognosis of necrotizing enterocolitis (NEC) according to the extent of involvement, among very low birth weight infants. Furthermore, the predictive factors for extent of involvement were evaluated. METHODS: Medical records of all newborns with surgically treated NEC admitted to the neonatal intensive care unit of Seoul National University Children's Hospital between 2005 and 2013 were reviewed. Infants were grouped according to the extent of involvement of NEC: isolated segment involvement (ISI, n=31) and multi-segment involvement (MSI, n=17). We evaluated the clinical characteristics, outcomes, and pre-operative factors according to symptoms, laboratory and radiologic findings. RESULTS: The incidence of small for gestational age was significantly higher in the MSI than ISI group (12.9% vs. 41.2%, P=0.036). The length of resected bowel was significantly longer (1.7 cm vs. 8 cm, P=0.010), and the incidence of short bowel syndrome (SBS) (0% vs. 23.1%, P=0.023) and mortality (3.2% vs. 23.5%, P=0.047) were significantly higher in the MSI than ISI group. However, there was no significant difference between the two groups in terms of high-output stoma, time of full enteral feeding, extrauterine growth retardation, changes of z-score of body weight between admission and discharge and reoperation. Portal vein gas detected by ultrasonography was the only statistically significant predictive factor of extent of involvement (odds ratio=13.237, P=0.029). CONCLUSION: SBS and mortality were higher in MSI NEC compared to ISI NEC. However, there was no difference in the time of full enteral feeding and growth between the two groups. Portal vein gas detected by ultrasonography maybe a predictive factor of extent of NEC.

The Importance of Gases in Portal Veins and Liver Parenchyme is Characterized by Liver Ultrasonography in Full-term Neonates with Necrotizing Enterocolitis

PURPOSE: Although early treatment of neonatal necrotizing enterocolitis (NEC) is very important, there exists no definite way of diagnosing NEC at an early stage. Previous reports argue that gases in portal veins and liver parenchyme are detected by liver ultrasonography (USG) even when no symptoms corresponding to NEC are provoked. This study demonstrates the importance of liver USG for early diagnosis of NEC. METHODS: Abdominal USG was performed on 1381 newborn infants who were admitted to the neonatal intensive care unit of Soonchunhyang University Cheonan Hospital between February 2003 and September 2005. Twelve infants were diagnosed with NEC by liver USG and their individual pathologies were compared. RESULTS: All of the patients described here were full-term and the most frequent symptom observed was watery diarrhea; four had no symptoms at all. Severe metabolic acidosis was seen in two patients, a rise of C-reactive protein (CRP) in five patients and rotavirus antigen positivity in five patients. One of the patients showed portal vein gas, pneumatosis intestinalis and ileus in a simple abdominal radiography and another patient showed ileus only. However, all of the other 10 patients presented with no abnormal symptoms, according to simple abdominal radiography. CONCLUSION: NEC should be considered in neonates with gases present in portal veins, intestinal walls and liver parenchyme, as detected by liver USG even when no symptoms corresponding to NEC are provoked.

A Case of Portal Vein Gas Embolism from Hydrogen Peroxide Ingestion / 대한내과학회지

We present a case of a 19-year-old male with portal vein gas embolism resulting from accidental ingestion of 35% hydrogen peroxide. Hydrogen peroxide is a commonly used germicidal cleansing agent. When it is applied to tissues, catalase causes its rapid molecular decomposition with the release of oxygen bubbles. The patient recovered without sequelae. Hyperbaric oxygenation may be of benefit in patients with respiratory compromise or central nervous system symptoms from gas embolism in hydrogen peroxide ingestion.