Utility of Serum L-lactate in Identifying Ischemia in Acute Intestinal Obstruction: A Prospective Observational Study.

Introduction In cases of intestinal obstruction, increasing luminal dilatation compromises bowel wall perfusion, eventually resulting in intestinal ischemia and bowel necrosis in advanced cases. Elevated L-lactate, as a biomarker of ischemia, may indicate the presence of bowel ischemia in cases of obstruction. The objective of this study was to evaluate the value of serum L-lactate measurement in predicting the presence of intraoperatively observed intestinal ischemia in patients with acute intestinal obstruction. Methods Patients diagnosed with acute intestinal obstruction were prospectively studied over an 18-month period. Serum L-lactate values were assayed twice: at the time of presentation and following appropriate fluid resuscitation. Receiver operating characteristic (ROC) curve analysis was applied to determine the predictive value of serum L-lactate in detecting intestinal ischemia. Results One hundred forty-four cases of intestinal obstruction were included in this study, of which 91 underwent operative intervention. Intestinal ischemia was identified in 52 cases and categorized intra-operatively as reversible (n = 33) and irreversible (n = 19). ROC analysis showed a good predictive value of serum L-lactate after fluid resuscitation for irreversible intestinal ischemia (area under the curve (AUC) = 0.884, 95% confidence interval (CI), 0.812-0.956). An L-lactate cut-off of 19.1 mg/dL following fluid resuscitation was determined to have a sensitivity of 89.5%, a specificity of 72.9%, a positive predictive value of 46.6%, and a negative predictive value of 96.3% for gangrenous bowel. Conclusion Serum L-lactate is a good predictive tool for identifying intestinal ischemia during the management of intestinal obstruction. Serum L-lactate after resuscitation showed better predictive value for ischemic bowel.

A Rare Complication in the Delayed Manifestation of Bochdalek Hernia During Pregnancy: A Case Report.

Acute gastric volvulus is a surgical emergency and is known to occur secondary to diaphragmatic hernia and eventration. Adult presentation of congenital diaphragmatic hernia is rare, with an estimated incidence of around 0.17%, and pregnancy may predispose to the development of symptoms due to increased intra-abdominal pressure. Pregnancy complicated by diaphragmatic hernia is associated with a high risk of maternal and fetal mortality, necessitating timely diagnosis and treatment. We present the case of a 23-year-old female presenting with a symptomatic left Bochdalek hernia complicated by organo-axial gastric volvulus during her second trimester (27 weeks). Emergency laparotomy was performed, with Caesarean section, reduction of gastric volvulus, and mesh repair of the left posterolateral defect.