Adriana Vargas-Rivas

L-lactato como marcador sérico de isquemia intestinal en pacientes con oclusión intestinal complicada

BACKGROUND The intestinal obstruction secondary to internal hernia is a diagnostic challenge. The absence of specific symptoms and signs during clinical examination often lead to underestimation of the severity and early surgical treatment. The purpose of this article is to review the clinical presentation of two patients with internal hernia, describe the clinical, biochemical and radiological findings, with emphasis on the L-lactate as an early serum marker of intestinal ischemia. CLINICAL CASES Case 1: female, 44 years history of urolithiasis and 2 cesarean sections. Case 2: female, 86 year old with a history of open cholecystectomy, incisional and bilateral inguinal hernia repair with mesh placement. Both admitted with abdominal pain and intestinal obstruction data. The only significant laboratory finding was elevation of L-lactate. The abdominal films showed air-fluid levels, dilated loops of small intestine and colon. Abdominal contrast tomography showed free abdominal fluid id, internal hernia and torque of mesentery. In both cases, exploratory laparotomy was performed with bowel resection of ischemic segments, with uneventful recovery. CONCLUSIONS Intestinal ischemia secondary to internal hernia is difficult lt to diagnose. In patients with a high suspicion, signs of intestinal obstruction by plain radiography, the elevation of L-lactate, could help in the early diagnosis of intestinal ischemia and immediate surgical treatment.