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Normal Lactate and Unenhanced CT-Scan Result in Delayed Diagnosis of Acute Mesenteric Ischemia
Abstract
INTRODUCTION: To investigate the factors associated with a delayed diagnosis (DD) of acute mesenteric ischemia (AMI). METHODS: An observational cohort study from an intestinal failure center. The primary outcome was DD >24 hours. RESULTS: Between 2006 and 2015, 74 patients with AMI were included and 39 (53%) had a DD. Plasma lactate <2 mmol/L (odd ratio: 3.2; 95% confidence interval: 1.1–9.1; P = 0.03) and unenhanced computed tomography scan (odds ratio: 5.9; 95% confidence interval: 1.4–25.8; P = 0.01) were independently associated with DD. DISCUSSION: Suspicion of AMI should no longer be affected by normal plasma lactate levels and should prompt evaluation by a contrast-enhanced computed tomography-scan.
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“Indeed, in a retrospective cohort study of survivors from mesenteric infarction, a delayed diagnosis was more frequent when initial plasma lactate concentrations were < 2 mmol/L, suggesting that physicians might be misguided by such unremarkable lactate levels [15].”
From Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: A cross-sectional study from an intestinal stroke center (2023) · cites this paper as [15]
In the citing paper
“In addition, when clinical suspicion of AMI is not evoked, it may be underdiagnosed on computed tomography (CT) scans of the abdomen as a result of either an inappropriate IV contrast protocol and/or an analysis that does not focus on the mesenteric vessels [14, 15].”
From Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: A cross-sectional study from an intestinal stroke center (2023) · cites this paper as [15]
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Self-citation
Metadata
- Authors
- Nuzzo, A., Joly, F., Ronot, M., Castier, Y., Huguet, A., Paugam-Burtz, C., Cazals-Hatem, D., Tran-Dinh, A., Becq, A., Panis, Y., Bouhnik, Y., Maggiori, L., Corcos, O., & on behalf of the SURVI group
- Affiliations
- Université Paris Cité (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- University of Paris, Paris, France;
- Corresponding author
- Nuzzo, Alexandre
- ORCID
- Venue
- American Journal of Gastroenterology
- Published
- 2020-08-26
- Volume
- 115
- Issue
- 11
- Pages
- 1902-1905
- ISSN
- 0002-9270 (ISSN-L)
- 1572-0241
- OpenAlex
- W3080285033
- Cited by
- 28
- References
- 15
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 6 · 2022: 8 · 2021: 5 · 2020: 1
- FWCI
- 4.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Omental and Epiploic Conditions
- Keywords
- acute mesenteric ischemia, delayed diagnosis, plasma lactate, unenhanced computed tomography, contrast-enhanced CT, intestinal failure
- MeSH terms
- Acute Disease, Adult, Anastomosis, Surgical, Chronic Disease, Colon, Contrast Media, Female, Humans, Intestine, Small, Jejunostomy, Male, Middle Aged, Retrospective Studies, Risk Factors, Short Bowel Syndrome, Tomography, X-Ray Computed, Vomiting, Cohort Studies, Abdominal Pain, Lactic Acid, Early Diagnosis, Delayed Diagnosis, Early Medical Intervention, Mesenteric Ischemia
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