Sakthivel, S (2016) A study on raised serum LDH level in acute intestinal Obstruction: A marker of bowel gangrene Coimbatore Medical College Hospital. Masters thesis, Coimbatore Medical College, Coimbatore.
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Abstract
INTRODUCTION: Intestinal obstruction accounts for 20% of all surgical emergencies around the world. Intestinal obstruction can result from variety of causes. When strangulation superimposes and blood supply to the bowel is compromised , it may lead to bowel gangrene. The most common cause of bowel gangrene secondary to mechanical obstruction is strangulated hernia in India and post operative adhesions in developed countries. Lactate dehydrogenase is an enzyme found abundant in intestinal mucosa and when the intestinal mucosa undergoes tissue hypoxia/ischemia, it is released into the serum and its serum level increases. Hence serial estimation of the serum LDH helps us to identify whether the obstruction goes on for gangrene or not. This study was conducted to emphasise the significance of early estimation of rise in LDH levels followed by early intervention which helps in reducing the morbidity and mortality caused by bowel gangrene following obstruction. OBJECTIVE OF THE STUDY: 1. To estimate the levels of serum LDH in patients presenting with symptoms of intestinal obstruction 2. To identify the patients with elevated levels of serum LDH and correlate the elevated levels of LDH with viability of the bowel. MATERIALS AND METHODS: In this study, the estimation of serum LDH was conducted in 45 cases of acute intestinal obstruction who were admitted in surgical wards of CMCH during the period of September 2014 to August 2015. LDH was estimated in all the cases preoperatively on the day of admission. Serum LDH was estimated in all the patients at the time of admission and the estimated value of serum LDH is compared with the viability of the bowel intra operatively. RESULTS: Among 45 patients presented with obstruction 20 patients had LDH level between 50 to 200 and all the 20 patients had normal bowel viability and 3 patients had LDH level between 200 to 400 and all the three patients had normal bowel viability. 4 Patients had LDH level between 400 to 800 and two of them had normal bowel viability and two others had bowel gangrene. 8 Patients had LDH level between 800 to 1200 and all of them had bowel gangrene. 10 Patients had LDH level more than 1200 and all of them had bowel gangrene. DISCUSSION: The normal level of serum LDH is 50 to 200 IU/L. Out of 45 patients 25 patients had elevated serum LDH which is about 55.56% and among those 25 patients, 20 patients found to have bowel gangrene which is about 80% . In our study the mean value of elevated serum LDH in bowel gangrene patients is 1037 IU/L. The incidence of bowel obstruction and gangrene is more common in males(72%) than females(28%). According to Muchas, an elevated level of LDH is found in 86% of patients who had bowel gangrene. “Lactate dehydrogenase is one of the markers of intestinal ischemia”. - Thompson. A study conducted by Lange.H, Jackel.R revealed an inference of 100% sensitivity and 42% specificity for increased LDH in patients presenting with acute abdomen who later are found to have intestinal ischemia and gangrene(34). Dr Neil R Feins suggested that the level of LDH can be taken as a criteria for intestinal obstruction. CONCLUSION: From this study it is evident that ischemic changes in any part of the bowel can cause elevation in the serum levels of LDH and a higher value of >1000 IU/L strongly indicates an underlying gangrenous change. It is a less invasive , cost effective and easily available diagnostic tool to diagnose bowel ischemia/gangrene. Hence it is more useful in centres where the diagnostic facilities are limited. The pre operative estimation of serum LDH levels in patients presenting with features of acute intestinal obstruction helps in identifying the patients who undergo intestinal ischemia and gangrene at the earliest which makes an early intervention possible and helps in reducing the morbidity and mortality due to bowel gangrene. Early diagnosis and early intervention is the key to reduce the mortality rate due to bowel gangrene. This study was conducted in Coimbatore medical college hospital and the results are similar and comparable to the other studies.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | raised serum LDH level ; acute intestinal Obstruction ; marker of bowel gangrene ; Coimbatore Medical College Hospital |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 27 Sep 2017 03:19 |
| Last Modified: | 27 Sep 2017 03:19 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3388 |
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