Authors: Neal Wilkinson
Publish Date: 2011/05/11
Volume: 15, Issue: 7, Pages: 1294-1294
Abstract
I read the May 2010 GI Image by Harb with interest in light of our recent publication on a similar topic1 In this case report they described a patient in multiorgan failure with small bowel pneumatosis and superior mesenteric and portal venous gas The authors clearly demonstrated dramatic images of gas within the bowel wall and liver which have often led clinicians to suspect an abdominal catastropheThe authors define portal pyemia as a combination of infection and thrombosis of the portal vein Unfortunately the selected images failed to demonstrate thrombosis of the portal vein and the laparotomy failed to identify clot in the superior mesenteric or portal vein The subsequent autopsy also failed to document thrombosis of the mesenteric or hepatic veins Why did the authors maintain a thrombosis theory when all proof was to the contrary No positive cultures were found in perioperative period at surgery and at autopsy They attribute the failure to obtain positive cultures to bacterial clearance within the liver and potent antibiotics Why did the authors not acknowledge that they may have been dealing with a nonbacterial phenomenonIn March 2010 journal we describe our experience with pneumatosis and portal vein gas in over 88 patients treated at the University of Iowa We found that in a large percentage of patients 30 there exists NO intraabdominal pathology In many cases a laparotomy may be necessary to “rule out” common intraabdominal catastrophes But when a laparotomy is nonrevealing and therefore nontherapeutic the clinicians must be capable of looking beyond the “gas” and vigorously explore and treat alternative diagnosis
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