Document Type : Original Article


1 Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 Road Traffic Injury Research Center, Department of Surgery, Tabriz University of Medical Sciences, Tabriz, Iran

3 Road Traffic Injury Research Center, Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

4 Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

5 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran


Objective: Acute mesenteric ischemia (IMA) is a vascular emergency with broad variability of clinical presentations and non-specific laboratory findings. Therefore, there is a significant need for reliable serological markers of ischemia. Various laboratory studies may be performed for suspected AMI, but in general, such studies will not establish the diagnosis.
Methods: In a prospective, non-interventional study, from October 2012 to October 2013, we investigated 70 patients with probable diagnosis of AMI. Blood samples were taken from patients and analyzed for complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), urea, creatinine (Cr), sodium (Na), potassium (K), D-dimer, lactate, amylase, PH, partial pressure of carbon dioxide (PCO2), and bicarbonate (HCO3). Finally the results were compared with AMI diagnosis confirmed by computed tomography (CT) angiography.
Results: Seventy patients with acute severe abdominal pain were studied. Thirty-nine patients (55.7%) were male and 31 patients (44.3%) were female. The average age was 68.01 ± 14.67 (±SD). Based on CT-angiography results, 27 (38.6%) patients had AMI and 43 (61.4%) patients did not have AMI. Chi-squire test showed P values of 0.606 and 0.986 for relations between sex and risk factors with AMI correspondingly. One-sample Kolmogorov-Smirnov revealed white blood cell (WBC), hemoglobin (Hb), platelets (Plt), urea, Cr, Na, K, PCO2 and HCO3 as normally distributed parameters (P > 0.05). Moreover PT, PTT, INR, D-dimer, lactate, amylase, and PH were non-normally distributed (P < 0.05).
Conclusion: We found a significant relation between increased serum lactate level and definitive AMI diagnosis. We recommend rising serum lactate as a finding in AMI.


Main Subjects

1. Belkin M, Owens CD, Whittemore AD. Peripheral Arterial Occlusive Disease. In: Townsend CM Jr, Beasuchamp RD, Evers BM, eds. Sabiston Text book of Surgery: The Biological Basis of Modern Surgical Practice. 18th ed. Philadelphia: WB Saunders; 2008. p. 1973-7.
2. Lin PH, Kougias P, Bechara C. Arterial disease. In: Brunicardi FC, Anderson DK, Billiar TR, eds. Schwartz’s Principles of Surgery. 9th ed. New York: McGraw-Hill; 2010. p. 730-6
3. Acosta S, Nilsson T. Current status on plasma biomarkers for acute mesenteric ischemia. J Thromb Thrombolysis 2012; 33(4): 355-61. doi: 10.1007/s11239-011-0660-z.
4. Chang RW, Chang JB, Longo WE. Update in management of mesenteric ischemia. World J Gastroenterol. 2006; 12(20): 3243-7. doi: 10.3748/wjg.v12.i20.3243.
5. Gearhart SL. Mesenteric vascular insufficiency. In: Longo DL, Fauci AS, eds. Harrison’s Principles of Interal Medicine. 18th ed. New York: McGraw-Hill; 2012. p. 2510-6.
6. Rosero O, Harsányi L, Szijártó A. Acute mesenteric ischemia: do biomarkers contribute to diagnosis. Orv Hetil 2014; 155(41): 1615-23. doi: 10.1556/oh.2014.30013. [Article in Hungarian].
7. Stone JR, Wilkins LR. Acute mesenteric ischemia. Tech Vasc Interv Radiol 2015; 18(1): 24-30. doi: 10.1053/j.tvir.2014.12.004.
8. Demir IE, Ceyhan GO, Friess H. Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia. Dig Surg 2012; 29(3): 226-35. doi: 10.1159/000338086.
9. Lange H, Jackel R. Usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease. Eur J Surg 1994; 160(6-7): 381-4.
10. Gearhart SL, Delaney CP, Senagore AJ, Banbury MK, Remzi FH, Kiran RP, et al. Prospective assessment of the predictive value of alpha-glutathione S-transferase for intestinal ischemia. Am Surg 2003; 69(4): 324-9.
11. Newman TS, Magnuson TH, Ahrendt SA, Smith-Meek MA, Bender JS. The changing face of mesenteric infarction. Am Surg 1998; 64(7): 611-6.
12. Klein HM, Lensing R, Klosterhalfen B, Töns C, Günther RW. Diagnostic imaging of mesenteric infarction. Radiology 1995; 197(1): 79-82.
13. Murray MJ, Gonze MD, Nowak LR, Cobb CF. Serum D(-)-lactate levels as an aid to diagnosing acute intestinal ischemia. Am J Surg 1994; 167(6): 575-8.
14. Kurimoto Y, Kawaharada N, Ito T, Morikawa M, Higami T, Asai Y. An experimental evaluation of the lactate concentration following mesenteric ischemia. Surg Today 2008; 38(10): 926-30. doi: 10.1007/s00595-007-3737-8.
15. Aydin B, Ozban M, Serinken M, Kaptanoglu B, Demirkan NC, Aydin C. The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia. Bratisl Lek Listy 2015; 116(5): 343-50. doi: 10.4149/bll_2015_094.
16. Chiu YH, Huang MK, How CK, Hsu TF, Chen JD, Chern CH, et al. D-dimer in patients with suspected acute mesenteric ischemia. Am J Emerg Med 2009; 27(8): 975-9. doi: 10.1016/j.ajem.2009.06.006.
17. Kulacoglu H, Kocaerkek Z, Moran M, Kulah B, Atay C, Kulacoglu S, et al. Diagnostic value of blood D-dimer level in acute mesenteric ischaemia in the rat: an experimental study. Asian J Surg 2005; 28(2): 131-5. doi: 10.1016/s1015-9584(09)60277-3.
18. Adam SS, Key NS, Greenberg CS. D-dimer antigen: current concepts and future prospects. Blood 2009; 113 (13): 2878-87. doi: 10.1182/blood-2008-06-165845.
19. Brill-Edward P, Lee A. D-dimer testing in the diagnosis of acute venous thromboembolism. Thromb Haemost 1999; 82(2): 688-94.
20. Kurt Y, Akin ML, Demirbas S, Uluutku AH, Gulderen M, Avsar K, et al. D-dimer in the early diagnosis of acute mesentericischemia secondary to arterial occlusion in rats. Eur Surg Res 2005; 37(4): 216-9. doi: 10.1159/000087866.
21. Altinyollar H, Boyabatli M, Berberoğlu U. D-dimer as a marker for early diagnosis of acute mesenteric ischemia. Thromb Res 2006; 117(4): 463-7. doi: 10.1016/j.thromres.2005.04.025.
22. Acosta S, Nilsson TK, Björck M. Preliminary study of D-dimer as a possible marker of acute bowel ischaemia. Br J Surg 2001; 88(3): 385-8. doi: 10.1046/j.1365-2168.2001.01711.x.
23. Abd-Elazeem A, Selim T. The role of plasma D-dimer levels in patients with acute mesenteric ischemia. Egypt J Surg 2006; 25: 60-65.
24. Akyildiz H, Akcan A, Oztürk A, Sozuer E, Kucuk C, Karahan I. The correlation of the D-dimer test and biphasic computed tomography with mesenteric computed tomography angiography in the diagnosis of acute mesenteric ischemia. Am J Surg 2009; 197(4):429-33. doi: 10.1016/j.amjsurg.2008.02.011.