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.

Diagnosis of Acute Mesenteric Ischemia in a Patient with End-Stage Renal Disease with Normal Serum Lactate

“…Apart from this, it is well known that the elevation of serum lactate may not be present in a significant portion of patients with AMI, as seen in our patient as well. It is also worth mentioning that existing studies could not establish a linear association between serum lactate level and the extent of bowel ischemia [2].…”

“…Acute mesenteric ischemia (AMI) is a life-threatening condition caused by a reduction of mesenteric blood flow with bowel ischemia and eventual gangrene of the bowel wall and has extremely high rates of mortality [1]. Early recognition of AMI can be notoriously difficult, and delayed intervention secondary to delays in diagnosis is one of the most common reasons for this extremely poor outcome [2].…”

Primary Small Bowel Volvulus: An Unusual Cause of Small Bowel Obstruction

“…Workup of SBV should include a thorough history and physical examination, biochemical analysis, and radiographic investigation ideally with an abdominal CT looking for a "whirlpool" or "barber pole" sign of mesenteric volvulus [5]. Among other biochemical markers, an elevated lactate level can signal mesenteric ischemia or necrosis, although this too can be normal despite abdominal catastrophe [6].…”

Understanding Visceral Ischaemia in Acute Type B Dissection: State of the Art, Challenges and Future Perspectives

“…On the other hand, available biomarkers have failed to demonstrate high sensitivity and specificity. As stated in the guidelines of the World Society of Emergency Surgery, "There are no laboratory studies that are sufficiently accurate to identify the presence or absence of ischemic or necrotic bowel, although elevated l-lactate, and d-dimer may assist," and this statement is supported by most of the available literature [30,43,44]. According to the European Society of Trauma and Emergency Surgery (ESTES), "Normal serum lactate level does not exclude acute mesenteric ischemia (AMI) and should not be used for diagnosis" [31].…”