title: Lactate levels in the detection of preoperative bowel strangulation.
abstract: The aim of this retrospective study was to examine whether various laboratory parameters could predict viability of strangulation in patients with bowel obstruction. Forty patients diagnosed with bowel strangulation were included. We performed operations for all patients within 72 hours  of the start of symptoms. Blood samples were obtained from all patients immediately before operation. Arterial blood was examined for pH and lactate levels using a blood gas analyzer. We also evaluated white blood cell count and serum levels of creatine phosphokinase, lactic dehydrogenase,  amylase, and C-reactive protein. At surgery, 18 patients had viable strangulation and did not undergo resection, whereas 22 had nonviable strangulation and underwent resection of the necrotic bowel. None of the patients died. Bowel strangulation was caused most commonly by adhesions. In terms  of diagnostic efficiency, lactate level was the only laboratory parameter significantly associated with viability (P < 0.01, Mann-Whitney test). Other laboratory data did not show statistically significant associations. These results suggest that arterial blood lactate level (2.0  mmol/L or greater) is a useful predictor of nonviable bowel strangulation.
authors.affiliation: Department of Surgery, Machida Municipal Hospital, Tokyo, Japan. keiichiro@jikei.ac.jp
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Tanaka
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Hanyu
authors.forename: Tomonori
authors.initials: T
authors.lastname: Iida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Watanabe
authors.forename: Susumu
authors.initials: S
authors.lastname: Kawano
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Usuba
authors.forename: Toshio
authors.initials: T
authors.lastname: Iino
authors.forename: Ryoji
authors.initials: R
authors.lastname: Mizuno
mesh_terms: D000368:Aged; D000681:Amylases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001784:Blood Gas Analysis; D002097:C-Reactive Protein / Q000378:metabolism; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007415:Intestinal Obstruction / Q000097:blood* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007773:Lactates / Q000097:blood*; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D007773:Lactates; D002097:C-Reactive Protein; D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase; D000681:Amylases