L-lactate as a serum marker of intestinal ischemia in patients with complicated intestinal obstruction

BackgroundThe intestinal obstruction secondary to internal hernia is a diagnostic challenge. The absence of specific symptoms and signs during clinical examination often lead to underestimation of the severity and its early surgical treatment. The purpose of this article is to review the clinical presentation of two patients with internal hernia, was well as to describe the clinical, biochemical and radiological findings, with emphasis on L-lactate as an early serum marker of intestinal ischaemia.Clinical casesCase 1: female, 44 years old, with a history of urolithiasis and 2 caesarean sections. Case 2: female, 86 years old, with a history of open cholecystectomy, incisional and bilateral inguinal hernia repair with mesh placement. Both admitted with abdominal pain and intestinal obstruction data. The only significant laboratory finding was elevation of L-lactate. The abdominal X-rays showed air-fluid levels, and dilated loops of small intestine and colon. Abdominal contrast tomography showed free abdominal fluid, internal hernia and mesenteric torsion. In both cases, exploratory laparotomy was performed with bowel resection of ischaemic segments, with uneventful recovery.ConclusionsIntestinal ischaemia secondary to internal hernia is difficult to diagnose. In patients with a high suspicion, signs of intestinal obstruction by plain radiography, and the elevation of L-Lactate, could help in the early diagnosis of intestinal ischaemia and its immediate surgical treatment