How to differentiate spontaneous intramural intestinal hemorrhage from acute mesenteric ischemia.
OBJECTIVE
The purpose of our study was to assess the diagnostic values of laboratory tests to differentiate spontaneous intramural intestinal hemorrhage (SIIH) from acute mesenteric ischemia (AMI) after abdominal computed tomography (CT) survey in the emergency department (ED).


METHODS
We retrospectively included 76 patients diagnosed SIIH or AMI after abdominal CT.


RESULTS
The mean ages of 28 SIIH patients and 48 AMI patients were 75.9 ± 13.7 years and 75.8 ± 11.6 years, respectively. Patients with SIIH had significantly higher rate of Coumadin use (P < .001) and localized tenderness (P < .05). In laboratory findings, SIIH patients had prolonged prothrombin time (PT) (83.6 ± 30.0 vs. 13.4 ± 3.2, P < .001), lower blood urea nitrogen (P < .05), lower creatinine (P < .05), and lower creatine kinase (P < .05). Prolonged PT showed good discriminative value to differentiate acute abdomen patients with SIIH from AMI after abdominal CT, with an area under the receiver operating characteristic curve of 0.980 (95% confidence interval, 0.918-0.998; P < .0001). Prolonged PT cut-off value of ≧22.5 seconds had a sensitivity of 92.9% and a specificity of 100%. Logistic regression analysis identified prolonged PT as an independent predictor of SIIH (odds ratio, OR, 22.2; P = .007).


CONCLUSIONS
Abdominal pain patients with either SIIH or AMI are rare in the ED, but abdominal CT sometimes cannot help to differentiate them due to similar CT findings. Prolonged PT might help emergency physicians and surgeons differentiate SIIH from AMI in such cases.
Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan; Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
Chia-Ying
CY
Tseng
Yu-Hui
YH
Chiu
Jui-Ling
JL
Chuang
Jen-Dar
JD
Chen
Hsien-Hao
HH
Huang
Chorng-Kuang
CK
How
David Hung-Tsang
DH
Yen
Mu-Shun
MS
Huang
D000368:Aged; D001806:Blood Urea Nitrogen; D003402:Creatine Kinase; D003404:Creatinine / Q000097:blood; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008643:Mesentery / Q000098:blood supply*; D011517:Prothrombin Time; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D003404:Creatinine; D003402:Creatine Kinase