Digestive Diseases and Sciences

, Volume 51, Issue 12, pp 2400–2403 | Cite as

The Relationship Between Intestinal Hypoperfusion and Serum D-Lactate Levels During Experimental Intra-Abdominal Hypertension

  • Arife Polat Duzgun
  • Baris Gulgez
  • Anil Özmutlu
  • Didem Ertorul
  • Güler Bugdayci
  • Nurten Akyurek
  • Faruk Coskun
Original Paper


Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) may result from several clinic situations and carries high morbidity and mortality risk, particularly in intensive care unit patients. The clinical spectrum changes from splanchnic hypoperfusion and intestinal ischemia to multiple organ failure. Previous studies demonstrated that serum D-lactate levels may be an early indicator in intestinal ischemia. This study aimed to investigate the relationship between intestinal ischemia and serum D-lactate levels during experimental IAH. Thirty-two male Wistar Albino rats weighing 250±50 g were divided into four groups. Three different intra-abdominal pressure (IAP) levels supplied by placement of an intraperitoneal Peritofix catheter and iso-osmotic polyethylene glycol infusion. Each of the IAP levels (15, 20, and 25 mm Hg groups) was checked with the monitor system and fixed for an hour. Control-group animals were not subjected to increased IAP. One hour later, 5-ml blood samples were taken for measurement of serum D-lactate levels and 2-cm intestinal tissue samples were taken 5 cm proximal to the ileocecal valve for histopathologic examination. Elevated serum D-lactate levels were recorded in animals with higher IAP levels.There was a positive correlation between serum D-lactate levels and IAP levels. Histological examinations of the intestinal tissue samples showed no significant pathologic changes in concordance with intestinal ischemia. Serum D-lactate levels may be an early indicator for increased IAP pressure before intestinal ischemic changes occur.


D-Lactate Intestinal hypoperfusion Intra-abdominal pressure Abdominal compartment syndrome 


  1. 1.
    Sanchez N, Tenofsky, et al. (2001) What is the abdominal pressure? Am Surg 67:243–248PubMedGoogle Scholar
  2. 2.
    Hong JJ, Cohn JM, Perez, Dolich MO, Brown M, McKenney (2002) Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 89:591–596CrossRefPubMedGoogle Scholar
  3. 3.
    McNellis J, Soffer S, Marini C, Ritter G (2002) Abdominal compartment syndrome in the surgical intensive care unit. Am Surg 68:18–23Google Scholar
  4. 4.
    Sieh KM, Kent, Chu M (2001) Intra-abdominal hypertension and abdominal compartment syndrome. Arch Surg 386:53–61CrossRefGoogle Scholar
  5. 5.
    Ivatury R, Diebel L, Porter J, Simon R (1997) Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am 77:783–800CrossRefPubMedGoogle Scholar
  6. 6.
    Diebel L, Dulchavsky S, et al. (1997) Splanchnic ischemia and bacterial translocation in the abdominal compartment syndrome. J Trauma 43:852–856PubMedGoogle Scholar
  7. 7.
    Kologlu M, Sayek I, Kologlu B, Demirali O (1999) Effect of persistently elevated intra-abdominal pressure on healing of colonic anastomoses. Am J Surg 178:293–297CrossRefPubMedGoogle Scholar
  8. 8.
    Meldrum D, Moore F, Moore E, Francois R (1997) Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 174:667–672CrossRefPubMedGoogle Scholar
  9. 9.
    Szalay L, Umar F, Kham A, et al. (2003) Increased plasma D-lactate is associated with the severity of hemorrhagic/traumatic shock in rats. Shock 3:245–251CrossRefGoogle Scholar
  10. 10.
    Murray M, Barbose J, Cobb C (1993) Serum D-lactate levels as a predictor of acute intestinal ischemia in a rat model. J Surg Res 54:507–509CrossRefPubMedGoogle Scholar
  11. 11.
    Murray M, Gonze M, Nowak L, Cobb C (1994) Serum D-lactate levels as an aid to diagnosing acute intestinal ischemia. Am J Surg 167:575–578CrossRefPubMedGoogle Scholar
  12. 12.
    Poeze M, Solberg B, Greve JW (2003) Gastric PgO2 and Pg-aCO2 gaps are related to D-lactate and not to L-lactate levels in patients with septic shock. Intensive Care Med 29:2081–2085CrossRefPubMedGoogle Scholar
  13. 13.
    Marti R, Vanela E, et al. (1997) Determination of D-lactate by enzymatic methods in biological fluids; study of interferences. Clin Chem 43:1010–1015PubMedGoogle Scholar
  14. 14.
    Chiu CT, McArdle AH, Brown R, Scott H, Gurd F (1970) Intestinal mucosal lesion in low flow states. Arch Surg 101:478–483PubMedGoogle Scholar
  15. 15.
    Malbrain M, Davide C, Pelosi P, Luciano G (2005) Incidence and prognosis of intra-abdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 33:315–322CrossRefPubMedGoogle Scholar
  16. 16.
    Rezende-Neto J, Moore E, Vinicius M, et al. (2002) Systemic inflammatory responses secondary to abdominal compartment syndrome; stage for muliple organ failure. J Trauma 53:1121–1128PubMedGoogle Scholar
  17. 17.
    Malbrain MLNG (1999) Abdominal pressure in the critically ill:measurement and clinical relevance. Intens Care 25:1453–1458CrossRefGoogle Scholar
  18. 18.
    Engum SA, Kogon B, Jensen E (2002) Gastric tonometry and direct intra-abdominal pressure monitoring in abdominal compartment syndrome. J Pediatr Surg 37:214–218CrossRefPubMedGoogle Scholar
  19. 19.
    Moore AFK, Hargest R, Martin M, Delicata RJ (2004) Intraabdominal hypertension and the abdominal compartment syndrome. Br J Surg 91:1102–1110CrossRefPubMedGoogle Scholar
  20. 20.
    Kirkpatrick A, Brenneman F, McLean R, Boulanger B (2000) Is clinical examination an accruate indicator of raised intra-abdominal pressure in critically injured patients? Can J Surg 43:207–211PubMedGoogle Scholar
  21. 21.
    Robotham J, Wise R, Bromberger B (1985) Effects of changes in abdominal pressure on left ventricular performance and regional blood flow. Crit Care Med 13:803–809PubMedCrossRefGoogle Scholar
  22. 22.
    Bloomfield G, Saggi B, Blocher C, Sugerman H (1999) Physiologic effects of externally applied continuous negative abdominal pressure for intra-abdominal hypertension. J Trauma 46:1009–1013PubMedGoogle Scholar
  23. 23.
    Oda J, Ivatury R, Blocher R, Malhotra A (2002) Amplified cytokine response and lung injury by sequential abdominal hemorrhagic shock and compartment syndrome in laboratory model of ischemia-reperfusion. J Trauma 52:625–632PubMedGoogle Scholar
  24. 24.
    Gudmundson FF, Gislason A, et al. (2001) Effects of prolonged increased intra-abdominal pressure on gastrointestinal blood flows in pigs. Surg Endosc 15:854–860CrossRefGoogle Scholar
  25. 25.
    Schachtrupp A, Graf J, Tons C, Hoer J (2003) Intravasculer volume depletion in a hour porcine model of intra abdominal hypertension. J Trauma 55:734–740PubMedGoogle Scholar
  26. 26.
    Doty J, Oda J, Ivatury R (2002) The effects of hemodynamic shock and increased intra-abdominal pressure on bacterial translocation. J Trauma 52:13–17PubMedCrossRefGoogle Scholar
  27. 27.
    Hunter JD, Damani Z (2004) Intra-abdominal hypertension and the abdominal compartment syndrome. Anaesthesia 59:899–907CrossRefPubMedGoogle Scholar
  28. 28.
    Hsu YP, Chen RJ, Feng J (2004) Increases suscepility to oxidant injury in hepatocytes from rats with intra-abdominal hypertension. J Trauma 57:569–575PubMedGoogle Scholar
  29. 29.
    Gracias V, Braslow B, Johnson J (2002) Abdominal compartment syndrome in the open abdomen. Arch Surg 137:1300–1306Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Arife Polat Duzgun
    • 1
  • Baris Gulgez
    • 1
  • Anil Özmutlu
    • 1
  • Didem Ertorul
    • 1
  • Güler Bugdayci
    • 1
  • Nurten Akyurek
    • 1
  • Faruk Coskun
    • 1
  1. 1.Third Department of SurgeryAnkara Numune Teaching and Research HospitalAnkara 06100Turkey

Personalised recommendations