The relationship between intestinal hypoperfusion and serum d-lactate levels during experimental intra-abdominal hypertension.

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) may result from several clinic situations and carries high morbidity and mortality risk, particularly in intensive care unit patients. The clinical spectrum changes from splanchnic hypoperfusion and intestinal ischemia to multiple organ failure. Previous studies demonstrated that serum D-lactate levels may be an early indicator in intestinal ischemia. This study aimed to investigate the relationship between intestinal ischemia and serum D-lactate levels during experimental IAH. Thirty-two male Wistar Albino rats weighing 250+/-50 g were divided into four groups. Three different intra-abdominal pressure (IAP) levels supplied by placement of an intraperitoneal Peritofix catheter and iso-osmotic polyethylene glycol infusion. Each of the IAP levels (15, 20, and 25 mm Hg groups) was checked with the monitor system and fixed for an hour. Control-group animals were not subjected to increased IAP. One hour later, 5-ml blood samples were taken for measurement of serum D-lactate levels and 2-cm intestinal tissue samples were taken 5 cm proximal to the ileocecal valve for histopathologic examination. Elevated serum D-lactate levels were recorded in animals with higher IAP levels. There was a positive correlation between serum D-lactate levels and IAP levels. Histological examinations of the intestinal tissue samples showed no significant pathologic changes in concordance with intestinal ischemia. Serum D-lactate levels may be an early indicator for increased IAP pressure before intestinal ischemic changes occur.

Emergency bowel surgery in the elderly.

BACKGROUND/AIMS: Emergency bowel operations are commonly performed in emergency units and carry high morbidity and mortality risk, particularly in elderly patients. The aim of the present study was to review the presentation, management and outcome of bowel emergencies in elderly patients. METHODS: The records of 248 patients (91 females, 157 males) aged over 65 years, undergoing emergency bowel operation during a five-year period, were reviewed. Patient's age, sex, details of presentation, past medial history, presence of coexisting diseases, and type of surgical procedures were noted, and their effects/any unfavorable outcomes were all analyzed. Data were evaluated by using SPSS 9.0 for Windows statistical program. A p value less than 0.05 was accepted as significant. RESULTS: Mean age was 72.5 years. There were 85 (34%) isolated small bowel emergencies (SBE) and 153 (62%) isolated large bowel emergencies (LBE). The most common disease in SBE was mesenteric ischemia in 67 (27%), followed by adhesions, 26 (10%). Malignant bowel disease in 59 (24%) and sigmoid volvulus in 43 (17%) accounted for the majority of LBE. Sixty-five percent (161) of patients presented with obstruction and 46 (19%) patients had bowel perforation. Malignant disease, volvulus and mesenteric ischemia carried high resection rates (82%, 78% and 76%, respectively). Overall morbidity and mortality rates were 42% (105) and 28% (70), respectively. CONCLUSIONS: Emergency bowel operations have poor outcome in the elderly. Nature and extent of disease, presence of coexisting cardiopulmonary disease, late admission and presence of peritonitis significantly affect management and outcome of elderly patients with bowel emergencies.