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Multimodality Diagnosis of Mesenteric Ischemia
05:07

Multimodality Diagnosis of Mesenteric Ischemia

Published on: July 21, 2023

977

Normal Lactate and Unenhanced CT-Scan Result in Delayed Diagnosis of Acute Mesenteric Ischemia

Alexandre Nuzzo1,2, Francisca Joly1,2, Maxime Ronot2,3

  • 1APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France.

The American Journal of Gastroenterology
|November 6, 2020
PubMed
Abstract

Insights

Normal plasma lactate levels do not rule out acute mesenteric ischemia (AMI). Unenhanced CT scans are associated with delayed diagnosis of AMI, prompting the need for contrast-enhanced imaging.

Area of Science:

  • Gastroenterology
  • Radiology
  • Emergency Medicine

Background:

  • Acute mesenteric ischemia (AMI) is a critical condition with high mortality.
  • Delayed diagnosis (DD) significantly worsens patient outcomes in AMI.
  • Identifying factors associated with DD is crucial for timely intervention.

Purpose of the Study:

  • To investigate predictors of delayed diagnosis in patients with acute mesenteric ischemia.
  • To identify clinical and radiological factors contributing to delayed AMI diagnosis.

Main Methods:

  • Observational cohort study conducted at an intestinal failure center.
  • Included 74 patients diagnosed with AMI between 2006 and 2015.
  • Primary outcome was defined as delayed diagnosis (DD) exceeding 24 hours.

Main Results:

  • Over half of patients (53%) experienced a delayed diagnosis of AMI.
  • Low plasma lactate levels (<2 mmol/L) were independently associated with DD (OR: 3.2, P=0.03).
  • Unenhanced computed tomography (CT) scans were also independently associated with DD (OR: 5.9, P=0.01).

Conclusions:

  • Normal plasma lactate levels should not deter suspicion of AMI.
  • The use of unenhanced CT scans may contribute to delayed diagnosis.
  • Contrast-enhanced CT scans are recommended for evaluating suspected AMI to avoid diagnostic delays.

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