Skip to main content

Is D-dimer a Predictor of Strangulated Intestinal Hernia?

World Journal of Surgery volume 30, pages 2165–2169 (2006)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Figure 1.
Figure 2.
Figure 3.

References

  1. Lange H, Jackel R. Usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease. Eur J Surg 1994;160:381–384

    PubMed  CAS  Google Scholar 

  2. Pott FE IV, Vukov LF. Utility of fever and leukocytosis in acute surgical abdomens in octogenarians and beyond. J Gerontol A Biol Sci Med Sci 1999;54:M55–M58

    Google Scholar 

  3. Salzano A, DeRosa A, Carbone M, et al. Computerized tomography features of intestinal infarction: 56 surgically treated patients with reversible mesenteric ischemia. Radiol Med 1999;97:246–250

    CAS  Google Scholar 

  4. Horgan PG, Gorey TF. Operative assessment of intestinal viability. Surg Clin North Am 1992;72:143–155

    PubMed  CAS  Google Scholar 

  5. Schoots IG, Levi M, Roossink EHP, et al. Local intravascular coagulation and fibrin deposition on intestinal ischemia–reperfusion in rats. Surgery 2003;133:411–419

    PubMed  Article  Google Scholar 

  6. Acosta S, Nilsson TK, Björck M. Preliminary study of D-dimer as a possible marker of acute bowel ischaemia. Br J Surg 2001;88:385–388

    PubMed  CAS  Article  Google Scholar 

  7. Acosta S, Bjorck M. Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population. Eur J Vasc Endovasc Surg 2003;26:179–183

    PubMed  CAS  Article  Google Scholar 

  8. Altinyollar H, Boyabatli M, Berberoglu U. D-dimer as a marker for early diagnosis of acute mesenteric ischemia. Thromb Res 2006;117:463–467

    PubMed  CAS  Article  Google Scholar 

  9. Wakai A, Gleeson A, Winter D. Role of fibrin D-dimer testing in emergency medicine. Emerg Med J 2003;20:319–325

    PubMed  CAS  Article  Google Scholar 

  10. Bick RL, Baker WF. Diagnostic efficacy of the D-dimer assay in disseminated intravascular coagulation (DIC). Thromb Res 1992;65:785–790

    PubMed  CAS  Article  Google Scholar 

  11. Harrison KA, Haire WD, Pappas AA, et al. Plasma D-dimer: a useful tool for evaluating suspected pulmonary embolus. J Nucl Med 1993;34:896–898

    PubMed  CAS  Google Scholar 

  12. Meissner MH, Zierler BK, Bergelin RO, et al. Markers of plasma coagulation and fibrinolysis after acute deep venous thrombosis. J Vasc Surg 2000;32:870–880

    PubMed  CAS  Article  Google Scholar 

  13. Fujii J, Takeuchi S, Harada A, et al. Hemostatic activation in spontaneous intracerebral hemorrhage. Stroke 2002;32:883–890

    Google Scholar 

  14. Danesh J, Whincup P, Walker M, et al. Fibrin D-dimer and coronary heart disease. Circulation 2001;103:2323–2327

    PubMed  CAS  Google Scholar 

  15. Quick G, Eisenberg P. Bedside measurement of D-dimer in the identification of bacteremia in the emergency department. J Emerg Med 2000;19:217–223

    PubMed  CAS  Article  Google Scholar 

  16. Engelman DT, Gabram SGA, Allen L, et al. Hypercoagulability following multiple trauma. World J Surg 196;20:5–10

  17. Kobayashi T, Tokunaga N, Sugimura M, et al. Predictive values of coagulation/fibrinolysis parameters for the termination of pregnancy complicated by severe preeclampsia. Semin Thromb Hemost 2001;27:137–141

    PubMed  CAS  Article  Google Scholar 

  18. Lip GY, Rumley A, Dunn FG, et al. Plasma fibrinogen and fibrin D-dimer in patients with atrial fibrillation. Int J Cardiol 1995;51:245–251

    PubMed  CAS  Article  Google Scholar 

  19. Lowe GDO, Rumley A. Use of fibrinogen and fibrin D-dimer in prediction of arterial thrombotic events. Thromb Haemost 1999;82:667–672

    PubMed  CAS  Google Scholar 

  20. Gutierrez A, Sanchez-Paya J, Marco P, et al. Prognostic value of fibrinolytic tests for hospital outcome in patients with acute upper gastrointestinal hemorrhage. J Clin Gastroenterol 2001;32:315–318

    PubMed  CAS  Article  Google Scholar 

  21. Oya M, Akiyama Y, Okuyama T, et al. High preoperative D-dimer level is associated with advanced tumor stage and short survival after curative resection in patients with colorectal cancer. Jpn J Clin Oncol 2001;31:388–934

    PubMed  CAS  Article  Google Scholar 

  22. Lowe GD, Yarnell JW, Rumley A, et al. C-reactive protein, fibrin D-dimer, and incident ischemic heart disease in the Speedwell Study: are inflammation and fibrin turnover linked in pathogenesis? Arterioscler Thromb Vasc Biol 2001;21:603–610

    PubMed  CAS  Google Scholar 

  23. Pieper CF, Rao KM, Currie MS, et al. Age, functional status, and racial differences in plasma D-dimer levels in community-dwelling elderly persons. J Gerontol Med Sci 2000;55:M649–M657

    CAS  Google Scholar 

  24. Giavarina D, Mezzena G, Dorizzi RM, et al. Reference interval of D-dimer in pregnant women. Clin Biochem 2001;34:331–333

    PubMed  CAS  Article  Google Scholar 

  25. Larsen JF, Ejstrud P, Svendsen F, et al. Randomized study of coagulation and fibrinolysis during and after gasless and conventional laparoscopic cholecystectomy. Br J Surg 2001;88:1001–1005

    PubMed  CAS  Article  Google Scholar 

  26. Karimova A, Pinsky DJ. The endothelial response to oxygen deprivation: biology and clinical implications. Intensive Care Med 2001;27:19–31

    PubMed  CAS  Article  Google Scholar 

  27. Biemond BJ, Levi M, Ten Cate H, et al. Plasminogen activator and plasminogen activator inhibitor I release during experimental endotoxaemia in chimpanzees: effect of interventions in the cytokine and coagulation cascades. Clin Sci 1995;88:587–594

    PubMed  CAS  Google Scholar 

Download references

Author information

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

Authors
  1. Gokhan Icoz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ozer Makay MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Murat Sozbilen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Baris Gurcu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cemil Caliskan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ozgur Firat MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zahide Kurt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sinan Ersin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ozer Makay MD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

  • Published:

  • Issue Date:

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

Keywords

  • International Normalize Ratio
  • Leukocyte Count
  • Serum Amylase
  • Intestinal Ischemia
  • Intestinal Resection