Gastric Pneumatosis with Portal Venous Gas can be Treated Non-operatively: A Retrospective Multi-institutional Study

Autor: Jean-Yves Mabrut, Pierre-Alexandre Ferrero, Niki Christou, Céline Lambert, Alexandros N. Flaris, Nicolas Williet, Rémi Grange, Antoine Epin, Guillaume Passot, Denis Pezet, Sebastien Caudron, Olivier Monneuse, Benoit Magnin, Bertrand Le Roy
Rok vydání: 2021
Předmět:
Zdroj: World journal of surgery. 46(4)
ISSN: 1432-2323
Popis: Background: Gastric pneumatosis (GP) is a rare radiologic finding with an unpredictable prognosis. The aim of this study was to identify mortality risk factors from patients presenting with GP on computed tomography (CT), and to develop a model which would allow us to predict which patients would benefit most from operative management.Methods: Between 2010 and 2020, all CT-scan reports in 4 tertiary centers were searched for the following terms: “gastric pneumatosis”, “intramural gastric air” or “emphysematous gastritis”. The retrieved CT scans were reviewed by a senior surgeon and a senior radiologist. Relevant clinical and laboratory data for these patients were extracted from the institutions’ medical records. Results: Among 58 patients with GP portal venous gas and bowel ischemia were present on CT scan in 52 (90%) and 17 patients (29%), respectively. The 30-day mortality rate was 31%. Univariate analysis identified the following variables as predictive of mortality at the time of the diagnosis of GP: abdominal guarding, hemodynamic instability, arterial lactate level >2mmol/l, and absence of gastric dilatation. Multivariable analysis identified the following variables as independent predictors of mortality: arterial lactate level (OR: 1.39, 95% CI: 1.07 - 1.79) and absence of gastric dilatation (OR: 0.07, 95% CI: 0.01 - 0.79). None of the patients presenting with a baseline lactate rate Conclusions: GP could be managed non-operatively, even in the presence of portal venous gas. However patients with arterial lactate level>2mmol/l, or absence of gastric dilation should be surgically explored due to a non-negligible risk of mortality.
Databáze: OpenAIRE