The early diagnosis of massive acute intestinal ischaemia

Abstract

Intestinal ischaemia with ensuing gangrene has been a serious clinical problem. Delay in diagnosis has inevitably led to either massive gut resection or death. It has been shown that the bowel contains high concentrations of both organic and inorganic phosphate. With gut ischaemia, phosphate is released from the bowel and elevated concentrations may be measured in peripheral blood, peritoneal fluid and urine. Associated leucocytosis and acidosis constitute a diagnostic laboratory triad. The alteration in gut phosphate metabolism has been studied extensively in dogs and humans. Under hypoxic conditions, a time period exists before irretrievable gut necrosis ensues. During this vital interval serum phosphate is elevated. In 20 clinical cases an accurate diagnosis of bowel ischaemia was made utilizing phosphate measurements. Three cases had an early diagnosis which led to embolectomy with no loss of gut. Elevated serum phosphate is an accurate diagnostic finding in early cases of massive gut ischaemia. It is hoped that this simple test may help lower the staggering mortality and morbidity associated with massive intestinal ischaemia.

Serum lactate and phosphate as biomarkers of intestinal ischemia in a Ugandan tertiary hospital: a cross-sectional study

“…Phosphate had no association with bowel ischemia in this study, which is a departure from the findings of Jamieson [18], who found phosphate to be significantly increased (in 80% of patients) in massive bowel ischemia. He however did not define what massive was.…”

Mesenteric Ischemia in Chronic Dialysis Patients

“…Admission leukocyte counts of 12.000 -40,000 were seen in all of our patients and in the patient described by Cryer and Kissane [14], Acidemia devel- oped only late and was usually present only after an abdominal catastrophe was clinically apparent [18]. Mild hyperphosphatemia was present in 2 of the 4 patients tested, but is not a useful indicator of ischemic bowel in the renal failure patient (table III) [19]. The mortality of acute mesenteric ischemia in our patients plus those pre viously described is similar to that reported in series on nonrenal patients [20,21].…”

Intestinal Ischemia/Reperfusion Injury: Defining the Role of the Gut Microbiome

“…The liver is largely responsible for the absorption of Pi, and as a result large volumes need to be produced by intestinal infarction before it becomes significantly raised in serum [93]. Clearly, Pi can be measured in biofluids such as urine, serum and peritoneal fluid without the need for NMR, but only with a statistical sensitivity of approximately 80% in human clinical studies [94].…”