Abstract
Background: Bowel gangrene is a major abdominal catastrophe associated with high mortality rate. Intestinal obstruction accounts for 20% of all surgical emergencies around the world. The present study aims to estimate the LDH levels in patients with acute intestinal obstruction and correlate with bowel viability. Subjects and Methods: In this study, the estimation of serum LDH was conducted in 45 cases of acute intestinal obstruction who were admitted in surgical wards. After fulfilling the inclusion and exclusion criteria the study subjects were recruited. All the cases were thoroughly examined. Time of presentation and onset of symptoms were noted. Under aseptic conditions, 3 ml venous blood samples were collected from the study subjects, centrifuged at 3000 rpm and separated serum sample was used for the estimation of lactate dehydrogenase (LDH) and the estimated value of serum LDH is compared with the viability of the bowel intra operatively. Results: The total number of patients presented with obstruction is 45 out of which 25 were found to have elevated LDH which is about 55.56%. Out of 25 patients presented with elevated LDH, 20 patients found to have gangrenous bowel. 60% presented with abdominal pain and 40% had irreducible swelling. Most commonly associated symptoms are vomiting (84%) followed by abdominal distension (40%), obstipation (36%), pyrexia (24%), blood in stools (8%) and diarrhoea (4%). Per rectal examination showed 76% had normal faecal staining, 12% blood stained faeces and 8% empty. Complications observed were anastomotic leak 8%, wound infection 16%, wound gaping 8%, burst abdomen 8%. Conclusion: The present study results indicate that ischemic changes in any part of the bowel can cause elevation in the serum levels of LDH and a higher value of >1000 IU/L strongly indicates an underlying gangrenous change. It is a less invasive, cost effective and easily available diagnostic tool to diagnose bowel ischemia/gangrene. Hence it is more useful in centres where the diagnostic facilities are limited.
Highlights
Bowel gangrene is a major abdominal catastrophe associated with high mortality rate
lactate dehydrogenase (LDH) activity is present in all the cells of the body predominantly in cytoplasm of the cell and when the intestinal mucosa undergoes tissue hypoxia/ischemia, it is released into the serum and its serum level increases. [4,5] Gut hypoxia causes anaerobic metabolism
[6] The present study aims to estimate the LDH levels in patients with acute intestinal obstruction and correlate with bowel viability
Summary
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 precised diagnostic tool for assessing bowel gangrene. [1,2]Intestinal obstruction accounts for 20% of all surgical emergencies around the world. The present study aims to estimate the LDH levels in patients with acute intestinal obstruction and correlate with bowel viability. Subjects and Methods: In this study, the estimation of serum LDH was conducted in 45 cases of acute intestinal obstruction who were admitted in surgical wards. Conclusion: The present study results indicate that ischemic changes in any part of the bowel can cause elevation in the serum levels of LDH and a higher value of >1000 IU/L strongly indicates an underlying gangrenous change. It is a less invasive, cost effective and available diagnostic tool to diagnose bowel ischemia/gangrene. It is more useful in centres where the diagnostic facilities are limited
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