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Masters Thesis | Surgery | India | Volume 13 Issue 9, September 2024 | Popularity: 5.2 / 10

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D-Lactate as Predictive Tool for Assessing Bowel Gangrene in Patients Admitted with Acute Intestinal Obstruction in Surgical Wards of Government Medical College Thiruvananthapuram

Dr. Sameena Chaloli, Dr. Jayan Stephan

Abstract: Introduction: Intestinal obstruction is one of the commonest clinical problems encountered in surgical practice. One of the grave complications of intestinal obstruction is strangulation and subsequent bowel gangrene. Which requires an emergency laparotomy for management. Bowel ischemia may arise from a number of causes affecting the arterial and venous compartments of the mesenteric circulation. The rapid onset of ischemia and the potential rapidity with which bowel infarction may occur explain the lethality of this disease. Ischemia, which complicate 7% to 42% of bowel obstruction, significantly increase mortality associated with bowel obstruction. Bowel gangrene is a major abdominal catastrophe associated with high mortality rate. This increased mortality is attributed to difficulty in diagnosing the condition early, the late presentation of the patient to the hospital and non - availability of pr?cised diagnostic tool for assessing bowel gangrene. This study was conducted to emphasis the significance of early estimation of rise in D - lactate levels in patients with intestinal obstruction. Objective: To study the diagnostic accuracy of D - lactate as predictive tool for assessing bowel gangrene in patients admitted with acute intestinal obstruction in surgical wards of Govt. Medical College, Thiruvananthapuram. Methodology: Design: Diagnostic Test Evaluation. Study Population: Inpatients at Department of General Surgery. Sampling: Consecutive Sampling. Subjects: All Patients (Age > 18 yrs) admitted with features of acute intestinal obstruction in general surgery wards of MCH, Thiruvananthapuram. Sample size: 125 Subjects. Data Collection and analysis: Data will be entered in excel sheets and analyzed using appropriate statistical software. All quantitative variables will be expressed as mean and standard deviation and all qualitative variables will be expressed as proportion. Receiver operating characteristic (ROC) curve will be drawn and cutoff values for the serum D - lactate will be calculate. Sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) will be calculated. Results: The study sample consisted of 125 persons. With 87 males (69.6%) and 38 females (30.4%). the age distribution is between 40 to 80 yrs., and most patients being the age group of 24 hrs. (68.8%). vomiting, obstipation generalized abdominal distention and abdominal pain are more frequent symptoms with significant history of previous abdominal surgery (31.2%). shock is associated with most of bowel gangrene cases (84.2%). exaggeration of bowel sounds is more common in simple bowel obstruction. It is found that significant abdominal tenderness and guarding /rigidity will be there in intestinal obstruction with bowel gangrene. In this study results ROC curve with AUC =0.891, when cut off value of serum lactate taken as 5 mmol/L, sensitivity of 85.71%, specificity of 88.89, PPV of 75% and NPV of 94.1% respectively. Conclusion: Intestinal obstruction is one of the commonest clinical problems encountered in surgical practice. One of the grave complications of intestinal obstruction is strangulation and subsequent bowel gangrene. Serum D - lactate can be useful and reasonable markers for predicting strangulation and bowel gangrene in cases of acute intestinal obstruction in an emergency setting. From the results of this study there is statistically significant relation between the serum lactate value and bowel gangrene. Higher the value serum lactate there is more chance of non - viability of bowel.

Keywords: D-lactate, Strangulation, Bowel, Gangrene, Ischemia, Markers

Edition: Volume 13 Issue 9, September 2024

Pages: 931 - 950

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