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Is D-dimer a Predictor of Strangulated Intestinal Hernia?

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Abstract

Background

The goal of this study was to assess the relevance of serum D-dimer measurement as a possible reliable marker for the diagnosis of strangulated intestinal hernia.

Methods

Consecutive patients admitted with nontraumatic acute abdominal gastrointestinal disorders were recruited prospectively in a tertiary referral hospital. The study was conducted in 159 patients between August 2002 and April 2004. D-dimer, lactate dehydrogenase, serum amylase, and international normalized ratio (INR) levels were tested in the emergency room prior to surgical intervention. For each patient, 15 variables, including D-dimer, were available for analysis.

Results

Thirty-three (20.7%) of the 159 patients had intestinal ischemia, and 28 (85%) of these 33 patients had D-dimer level > 300 ng/ml. Plasma levels of D-dimer in patients with intestinal ischemia were significantly higher than in patients without ischemia (P < 0.05). There were 29 (18.2%) patients in the hernia group with incarceration (n = 22) or strangulation requiring resection (n = 7). D-dimer levels in patients requiring intestinal resection were insignificantly higher than in patients without resection (P > 0.05). Six (85%) of the 7 hernia patients requiring resection had D-dimer levels > 360 ng/ml. The D-dimer variable correlated best with the leukocyte count in patients with hernia requiring resection. Levels of lactate dehydrogenase, serum amylase, and INR did not show any correlation with D-dimer levels.

Conclusions

To help predict ischemic events, the increasing use of the D-dimer assay in clinical practice could be extended to patients presenting with intestinal emergencies. An elevated D-dimer level on admission had a high sensitivity for identifying patients with intestinal ischemia, although it had a low specificity. Whether it is predictive or preventive for resection in strangulated intestinal hernia patients still remains a question.

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Authors and Affiliations

  1. Department of General Surgery, Ege University Hospital, Izmir, Turkey, 35100

    Gokhan Icoz MD, Ozer Makay MD, Murat Sozbilen MD, Baris Gurcu MD, Cemil Caliskan MD, Ozgur Firat MD, Zahide Kurt MD & Sinan Ersin MD

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  1. Gokhan Icoz MD
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  2. Ozer Makay MD
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  3. Murat Sozbilen MD
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  4. Baris Gurcu MD
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  5. Cemil Caliskan MD
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  6. Ozgur Firat MD
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  7. Zahide Kurt MD
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  8. Sinan Ersin MD
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Correspondence to Ozer Makay MD.

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Icoz, G., Makay, O., Sozbilen, M. et al. Is D-dimer a Predictor of Strangulated Intestinal Hernia?. World J. Surg. 30, 2165–2169 (2006). https://doi.org/10.1007/s00268-006-0138-x

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  • DOI: https://doi.org/10.1007/s00268-006-0138-x

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