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Invited Critique
June 15, 2009

Hepatic Portal Venous Gas—Invited Critique

Arch Surg. 2009;144(6):581. doi:10.1001/archsurg.2009.87

Nelson and colleagues describe an important and potentially life-threatening clinical condition—HPVG. They present a clearly written and very educational overview.

According to the given algorithm, the finding of HPVG in abdominal radiographs should lead directly to an emergency laparotomy. This assumption is based on the results of historical reports, in particular the review of the literature by Liebman et al1 with a mortality rate of 75% in patients with HPVG detected on abdominal radiographs published in 1978. It is questionable if this guideline is still applicable because in most departments a CT scan is available in the emergency setting and will be included in the diagnostic workup for most patients before an emergency laparotomy should be performed.

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