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Effectiveness of Diagnostic Paracentesis and Ascites Analysis for Suspected Strangulation Obstruction

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Strangulation obstruction is a surgical emergency, but its accurate diagnosis and timely surgical treatment are still matters of debate. We conducted a prospective observational study. We performed diagnostic paracentesis preoperatively for patients with suspected strangulation obstruction or, if that was impossible, we obtained ascites at the time of laparotomy. We examined each specimen to see whether ascites color and laboratory parameters could be reliable indicators of strangulation obstruction. During 18 months, 32 patients had suspected strangulation obstruction. At laparotomy, we confirmed strangulation obstruction in 21 patients, simple obstruction in two patients, and pseudo-obstruction in one patient. We treated eight patients conservatively, including one patient with a complication. We identified ascites red blood cell count, hematocrit, and lactic acid as indicators for strangulation obstruction by univariate analysis. An ascites red blood cell count was statistically high in cases with strangulation obstruction by multivariate analysis. Ascites red blood cell count above 20,000/mm3 had a positive predictive value for strangulation obstruction of 100%, and above 40,000/mm3, bowel resection was highly necessary. Diagnostic paracentesis and ascites analysis are useful methods for diagnosis of strangulation obstruction. Diagnostic paracentesis and ascites analysis should be combined with careful clinical exams for diagnosis of strangulation obstruction.

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References

  1. Fevang BT, Fevang J, Stangeland L, Soreide O, Svanes K, Viste A. Complications and death after surgical treatment of small bowel obstruction: A 35-year institutional experience. Ann Surg 2000;231(4):529–537.

    Article  PubMed  CAS  Google Scholar 

  2. Shatila AH, Chamberlain BE, Webb WR. Current status of diagnosis and management of strangulation obstruction of the small bowel. Am J Surg 1976;132(3):299–303.

    Article  PubMed  CAS  Google Scholar 

  3. Silen W, Hein MF, Goldman L. Strangulation obstruction of the small intestine. Arch Surg 1962;85:121–129.

    PubMed  CAS  Google Scholar 

  4. Sarr MG, Bulkley GB, Zuidema GD. Preoperative recognition of intestinal strangulation obstruction. Prospective evaluation of diagnostic capability. Am J Surg 1983;145(1):176–182.

    Article  PubMed  CAS  Google Scholar 

  5. Leffall LD, Syphax B. Clinical aids in strangulation intestinal obstruction. Am J Surg 1970;120(6):756–759.

    Article  PubMed  CAS  Google Scholar 

  6. Fevang BT, Fevang JM, Soreide O, Svanes K, Viste A. Delay in operative treatment among patients with small bowel obstruction. Scand J Surg 2003;92(2):131–137.

    PubMed  CAS  Google Scholar 

  7. Grassi R, Romano S, D’Amario F, Giorgio Rossi A, Romano L, Pinto F, Di Mizio R. The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults. Eur J Radiol 2004;50(1):5–14.

    Article  PubMed  Google Scholar 

  8. Zalcman M, Sy M, Donckier V, Closset J, Gansbeke DV. Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction. AJR Am J Roentgenol 2000;175(6):1601–1607.

    PubMed  CAS  Google Scholar 

  9. Evers BM. Obstruction. In Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery, 16th ed. Philadelphia: W.B. Saunders, 2001, pp 882–888.

  10. Sullins KE, Stashak TS, Mero KN. Pathologic changes associated with induced small intestinal strangulation obstruction and nonstrangulating infarction in horses. Am J Vet Res 1985;46(4):913–916.

    PubMed  CAS  Google Scholar 

  11. Ergene U, Coskun F, Eray O, Gokce O, Fowler J, Haciyanli M, Tasar Z, Nur User N. Current value of peritoneal tap in blunt abdominal trauma. Eur J Emerg Med 2002;9(3):253–257.

    Article  PubMed  CAS  Google Scholar 

  12. Sloop RD. The dominant role of paracentesis technics in the early diagnosis of blunt abdominal trauma. Am J Surg 1978;136(1):145–150.

    Article  PubMed  CAS  Google Scholar 

  13. Delany HM, Moss CM, Carnevale N. The use of enzyme analysis of peritoneal blood in the clinical assessment of abdominal organ injury. Surg Gynecol Obstet 1976;142(2):161–167.

    CAS  Google Scholar 

  14. Mansberger ARJ. Value of peritoneal fluid ammonia levels in the differential diagnosis of the acute abdomen. Ann Surg 1962;155:998–1010.

    Article  PubMed  Google Scholar 

  15. Silen W. Acute intestinal obstruction. In: Cope’s early diagnosis of the acute abdomen, 20th ed. New York: Oxford University Press, 2000, pp 150–174.

  16. Shoemaker WC, Appel P, Bland R. Use of physiologic monitoring to predict outcome and to assist in clinical decisions in critically ill postoperative patients. Am J Surg 1983;146(1):43–50.

    Article  PubMed  CAS  Google Scholar 

  17. Manikis P, Jankowski S, Zhang H, Kahn RJ, Vincent JL. Correlation of serial blood lactate levels to organ failure and mortality after trauma. Am J Emerg Med 1995;13(6):619–622.

    Article  PubMed  CAS  Google Scholar 

  18. McNelis J, Marini CP, Jurkiewicz A, Szomstein S, Simms HH, Ritter G, Nathan IM. Prolonged lactate clearance is associated with increased mortality in the surgical intensive care unit. Am J Surg 2001;182(5):481–485.

    Article  PubMed  CAS  Google Scholar 

  19. Giacobine JW, Silver VE. Evaluation of diagnostic abdominal paracentesis with experimental and clinical studies. Surg Gynecol Obstet 1960;110:676–686.

    PubMed  CAS  Google Scholar 

  20. Rao RN, Ravikumar TS. Diagnostic peritoneal tap. Int Surg 1977;62(1):14–16.

    PubMed  CAS  Google Scholar 

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Acknowledgements

The authors would like to thank all the surgical attending physicians and residents at Okinawa Chubu Hospital for their dedication and hard work in managing the study. The authors would also like to thank all the colleagues who managed the database.

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Authors and Affiliations

  1. Department of Surgery, Okinawa Chubu Hospital, Okinawa, Japan

    Shin Kobayashi, Kenji Matsuura, Kazuhide Matsushima, Kazuaki Okubo, Eisei Henzan & Masao Maeshiro

  2. Department of Surgery, Okinawa Yaeyama Hospital, 732, Okawa, Ishigaki, Okinawa, 907-0022, Japan

    Shin Kobayashi

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  1. Shin Kobayashi
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  2. Kenji Matsuura
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  3. Kazuhide Matsushima
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  4. Kazuaki Okubo
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  5. Eisei Henzan
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  6. Masao Maeshiro
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Correspondence to Shin Kobayashi.

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Kobayashi, S., Matsuura, K., Matsushima, K. et al. Effectiveness of Diagnostic Paracentesis and Ascites Analysis for Suspected Strangulation Obstruction. J Gastrointest Surg 11, 240–246 (2007). https://doi.org/10.1007/s11605-007-0092-4

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  • DOI: https://doi.org/10.1007/s11605-007-0092-4

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