title: Can the Preoperative Serum Lactate Level Predict the Extent of Bowel Ischemia in Patients Presenting to the Emergency Department with Acute Mesenteric Ischemia?
abstract: Purpose.Early recognition of acute mesenteric ischemia (AMI) can be challenging. Extensive bowel necrosis secondary to AMI is associated with high rates of mortality. The aim of this study was to investigate the association between preoperative serum lactate level and the extent of bowel ischemia in patients with AMI.Methods.Data of patients with abdominal pain and elevated serum lactate undergoing emergency laparotomy for suspected AMI within 24 hours of presentation was retrospectively abstracted. The length of the ischemic bowel segment was compared with the preoperative serum lactate level.Results.36 female and 39 male patients, with median age 73.1 ± 12.3 years, were included for analysis. The median preoperative lactate was 2.96 ± 2.59 mmol/l in patients with ≤50 cm, 6.86 ± 4.08 mmol/l in patients with 51-100 cm, 4.73 ± 2.76 mmol/l in patients with >100 cm ischemic bowel, and 14.07 ± 4.91 mmol/l in the group with multivisceral ischemia.Conclusion.Although elevated serum lactate might permit an early suspicion and thus influence the clinical decision-making with regard to prioritization of surgery in patients with suspected AMI, a linear relationship between serum lactate and the extent of bowel ischemia could not be established in this study.
authors.affiliation: Department of Surgery II, HELIOS Universitätsklinikum Wuppertal, Witten-Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany.
authors.forename: Peter C
authors.identifier: 0000-0002-6614-3480
authors.initials: PC
authors.lastname: Ambe
authors.affiliation: Department of Surgery II, HELIOS Universitätsklinikum Wuppertal, Witten-Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Kang
authors.affiliation: Department of Surgery II, HELIOS Universitätsklinikum Wuppertal, Witten-Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany.
authors.forename: Marios
authors.initials: M
authors.lastname: Papadakis
authors.affiliation: Department of Surgery II, HELIOS Universitätsklinikum Wuppertal, Witten-Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany.
authors.forename: Hubert
authors.initials: H
authors.lastname: Zirngibl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007422:Intestines / Q000503:physiopathology*; D007511:Ischemia / Q000097:blood*; D019344:Lactic Acid / Q000097:blood*; D007813:Laparotomy; D008297:Male; D065666:Mesenteric Ischemia / Q000097:blood* / Q000601:surgery; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D019344:Lactic Acid