Abstract
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 four 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 >2 mmol/l, and the 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 the absence of gastric dilatation (OR: 0.07, 95% CI: 0.01–0.79). None of the patients presenting with a baseline lactate rate<2 mmol/l died within 30 days following diagnosis, and no more than 17 patients out of 58 had bowel ischemia (29%).
Conclusions
GP could be managed non-operatively, even in the presence of portal venous gas. However, patients with arterial lactate level>2 mmol/l, or the absence of gastric dilation should be surgically explored due to a non-negligible risk of mortality.
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AE, GP, BLR and AF contributed to design of the work.NK, OM, JYM, PAF, SC, DP, BM, RG, NW contributed to acquisition and analysis of the work. CL contributed to interpretation of data. All authors have approved the submitted version (and any substantially modified version that involves the author's contribution to the study). All authors have agreed both to be personally accountable for the author's own contributions and ensured that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature abdominal.
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The authors declare that they comply with journal’s ethical policies. The anonymous data collection was supported by an ethical approval with ID IRBN702021/CHUSTE issued by the Institutional Review Board: IORG0007394.
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Epin, A., Passot, G., Christou, N. et al. Gastric Pneumatosis with Portal Venous Gas can be Treated Non-operatively: A Retrospective Multi-institutional Study. World J Surg 46, 784–790 (2022). https://doi.org/10.1007/s00268-021-06433-5
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DOI: https://doi.org/10.1007/s00268-021-06433-5