Predictors of prognosis in children with portal venous gas detected by ultrasound.

Abstract

To evaluate ultrasound findings in order to determine potential predictors of prognosis in pediatric patients withportal venous gas (PVG) detected by ultrasound. Thirty-nine children were included and divided intotwo groups: benign PVG (n=24) and life-threatening PVG (n=15; 6 surgical interventions and 9 deaths). Possible predictors,i.e., the location of PVG in the liver, the distribution of intestinal pneumatosis, ascites and free air were compared betweenthe two groups. A significant difference was noted between the two groups in terms of the distribution of intestinalpneumatosis (limited to the large bowel, benign vs life-threatening = 60.9% (14/23):21.4% (3/14), p=0.040), the absenceof ascites (benign vs life-threatening = 79.1% (19/24):40.0% (6/15), p=0.019) and patient age (benign vs life-threatening =52.5±65.3 months vs 19.7±44.0 months, p=0.019). No significant difference was observed in the location of PVG in the liver, the presence of free air, and sex between the two groups. In pediatric patients with PVG, including various agesand underlying diseases, intestinal pneumatosis limited to the large bowel and absence of ascites were predictors of a benignprognosis. However, despite the presence of these predictors, some patients with PVG required surgical intervention, therebysuggesting that the cause of PVG, such as necrotizing enterocolitis, volvulus, or pancreatitis, must be also carefully evaluated.