gms | German Medical Science

Background: Serum lactate level is often used as a surrogate marker for tissue hypoperfusion. Early recognition of mesenteric ischemia can be challenging. Extensive bowel necrosis secondary to mesenteric ischemia is associated with high rates of mortality. The aim of this study was to investigate whether or not the preoperative level of lactate correlates with the extent of bowel involvement in patients with acute mesenteric ischemia

Materials and methods: Data of patients with elevated serum lactate undergoing emergency surgery for suspected acute mesenteric ischemia was retrospectively analyzed. The length of the ischemic bowel segment was correlated with the preoperative lactate level.

Results: Seventy five cases, including 36 female and 39 male patients were included for analysis. The mean age of the study population was 73.1 ± 12.3 years. Over 80% of the study population presented with concomitant conditions (ASA >2). The length of bowel resected was ≤ 50 cm in 29 cases (38.7%), 51 – 100 cm in 13 cases (17.3%) and > 100 cm in 15 cases (20%). Bowel resection was not performed in 18 cases (24%): seven after hernia reposition, four following embolectomy and seven with multivisceral ischemia. The mean preoperative lactate was 2.91 mmol/l in the group with ≤ 50 cm bowel resection, 6.86 in the group with 51-100 cm, 5.5 mmol/l in the group with > 100 cm and 9.5 mmol/l in the group with multivisceral ischemia. The mean preoperative lactate increased significantly with increasing ischemic areal, p = 0.001.

Conclusion: Preoperative serum lactate level correlates with the extent of bowel ischemia in patients presenting with acute mesenteric ischemia.