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Vol. 68. Issue 6.
Pages 361-366 (June - July 2021)
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Vol. 68. Issue 6.
Pages 361-366 (June - July 2021)
Case report
DOI: 10.1016/j.redare.2020.08.009
Postoperative lactate elevation as a marker of underlying acute mesenteric ischemia. Description of two cases
Elevación del lactato en el postoperatorio como marcador de isquemia mesentérica aguda. Descripción de dos casos
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A. Prado Rodríguez
Corresponding author
ana.prado.rodriguez@sergas.es

Corresponding author.
, R. Mato Búa, L. Mera Mujico, J. Arca Suárez, M. López Sánchez, L. Sampayo Rodríguez, P. Rama-Maceiras
Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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Table 1. Changes in blood gas and labs in patient 1.
Table 2. Changes in blood gas and labs in patient 2.
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Abstract

Serum lactate is a non-specific marker of tissue hypoperfusion. Elevated serum lactate is used in the differential diagnosis of acute intestinal ischemia. Although this practice is controversial, in the absence of other validated markers lactate is still used because of its high sensitivity.

We present the cases of two patients who developed acute mesenteric ischemia as a post-surgical complication. The patients reported moderate abdominal pain —a non-specific symptom in the postoperative context— and tests showed progressively increasing serum lactate levels, which facilitated suspicion and subsequent diagnostic confirmation through an imaging test.

These cases highlight the physiopathological importance of lactate elevation in the perioperative context and of performing a differential diagnosis of its possible causes, including mesenteric ischemia. Although the outcome was negative in the first case, early suspicion allowed us to make an effective diagnosis and administer appropriate treatment in the second patient.

Keywords:
Lactate
Mesenteric ischemia
Postoperative complications
Biomarkers
Resumen

El lactato sérico es un marcador inespecífico de hipoperfusión tisular. El diagnóstico diferencial de su elevación incluye la isquemia intestinal aguda. A pesar de ser controvertido para este uso, el lactato se sigue empleando, por su elevada sensibilidad y a falta de otros marcadores validados.

Presentamos los casos de 2 pacientes que desarrollaron como complicación posquirúrgica una isquemia mesentérica aguda, que cursó con dolor abdominal moderado —un síntoma inespecífico en el contexto postoperatorio— y unos niveles de lactato sérico en aumento progresivo, lo que facilitó la sospecha y la posterior confirmación diagnóstica mediante una prueba de imagen.

Se destaca la importancia fisiopatológica de la elevación del lactato en el contexto perioperatorio, que debe llevar a realizar un diagnóstico diferencial de sus posibles causas, incluyendo entre las mismas la isquemia mesentérica; pues aunque en el primer caso el desenlace fue negativo, la sospecha precoz permitió en el segundo, realizar un diagnóstico y tratamiento efectivos.

Palabras clave:
Lactato
Isquemia mesentérica
Complicaciones postoperatorias
Biomarcadores

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