No abstract

Ann R Coll Surg Engl 2010; 92:1 Hepatoportal venous gas (HPVG) was originally reported in adults in the 1960s and was almost exclusively associated with mesenteric ischaemia.1 Original reports described the finding of HPVG as signifying an intra-abdominal catastrophe, indicating a need for immediate laparotomy. Mortality rates in patients with HPVG approached 90%; even 18 years later, mortality was 75%.2 More recent reports still show HPVG to be a very poor prognostic sign (30-40% mortality) although the increased use and improved resolution of computed tomography (CT) scans has shown HPVG can result from a number of gastrointestinal pathologies, some of which may not indicate immediate laparotomy. It has been reported in inflammatory bowel disease, pancreatitis, diverticulitis, perforation of gastric ulceration, obstruction and even endoscopic evaluation of the gastrointestinal system. In a review in 2001, of 182 patients with HPVG, only 46% underwent surgery and mortality was not significantly different from those managed conservatively.3 This highlights the emerging belief that HPVG is not always associated with profound abdominal sepsis requiring surgical intervention. This article reports a case presenting in with HPVG noted on a follow-up CT. Case historyA 55-year-old woman had originally been admitted under the care of rheumatology physicians for medical control of her Behcet's disease. During this time, she developed left iliac fossa pain and a CT scan revealed sigmoid diverticular disease and stranding of the pericolic fat, consistent with diverticulitis. An incidental renal mass was also noted which, although thought to be a benign complex cyst, required further follow-up imaging. She was managed with Often believed to be a poor prognostic sign, hepatoportal venous gas (HPVG) has been associated with massive intra-abdominal sepsis. It is more frequently detected as computed tomography imaging techniques improve. A patient presenting with radiological evidence of HPVG is discussed and the literature reviewed. This study aims to highlight the increasing understanding that HPVG may sometimes follow a more indolent course than previously believed. Patient assessment is the key in selecting those who need urgent laparotomy. Figure 1 CT image of gas in the hepatic venules in the left lobe of the liver in the presented patient. It is differentiated from pneumobilia by being more peripheral and extending out to the liver surface. ON-LINE CASE REPORT

No abstract

BackgroundAcute exacerbations of COPD (AECOPD) are the second most common cause of emergency hospital admission in England and are associated with an inpatient mortality rate of 4.3%.1 The Dyspnoea, Eosinopenia, Consolidation, Acidaemia and Atrial Fibrillation (DECAF) Score, is an effective prognostic tool that predict mortality in AECOPD admissions. This scoring system is easy to apply during admission and has performed better than existing prognostic tools.2 We aim to appraise the efficacy of DECAF score in our busy respiratory and medical admissions unit.MethodHospital admissions with AECOPD from Dec 2014 to Mar 2015 are prospectively reviewed and DECAF score applied to each patient. Morbidity and mortality indicators were then correlated with both total DECAF scores and each predictive index.Results78 admissions were reviewed, 60% were male and the mean age was 72.7 years. Average length of stay was 15.3 days and 12 patients died in hospital. Our results were comparable with previous studies3, with inpatient mortality highest in those with DECAF scores of 3–5 (92%) and lowest in those with scores of 0–1 (0%). Higher DECAF scores were also associated with use of non-invasive ventilation (43%).Furthermore, each individual predictive index within the DECAF score was independently related to an increased mortality rate. There was 44% mortality in patients with atrial fibrillation and 30% mortality in patients with dyspnoea score of eMRC 5B. In-hospital mortality rate increased with each DECAF score (Figure 1).Abstract P45 Figure 1 ConclusionsIntroduction of DECAF score as clinical prediction tool for AECOPD admissions in our departments may be beneficial in reducing morbidity and mortality. Those scoring highest should be considered for early escalation, higher level of care and or palliative management. Those with lower scores may be suitable for early supported discharge. Further study of a larger group however is advisable to confirm the significance of these findings.References1 National Chronic Obstructive Pulmonary Disease Audit Programme: Clinical audit of COPD exacerbations admitted to acute units in England and Wales, 20142 J Steer, J Gibson, S Bourke. The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease. Thorax 2012;67:970–976

No abstract