Abstract
Objects
The purpose of our study was to assess the diagnostic values of laboratory tests to
differentiate spontaneous intramural intestinal hemorrhage (SIIH) from acute mesenteric
ischemia (AMI) after abdominal computed tomography (CT) survey in the emergency department
(ED).
Method
We retrospectively included 76 patients diagnosed SIIH or AMI after abdominal CT.
Results
The mean ages of 28 SIIH patients and 48 AMI patients were 75.9 ± 13.7 years and 75.8
± 11.6 years, respectively. Patients with SIIH had significantly higher rate of Coumadin
use (P < .001) and localized tenderness (P < .05). In laboratory findings, SIIH patients had prolonged prothrombin time (PT)
(83.6 ± 30.0 vs. 13.4 ± 3.2, P < .001), lower blood urea nitrogen (P < .05), lower creatinine (P < .05), and lower creatine kinase (P < .05). Prolonged PT showed good discriminative value to differentiate acute abdomen
patients with SIIH from AMI after abdominal CT, with an area under the receiver operating
characteristic curve of 0.980 (95% confidence interval, 0.918-0.998; P < .0001). Prolonged PT cut-off value of ≧22.5 seconds had a sensitivity of 92.9% and a specificity of 100%. Logistic regression
analysis identified prolonged PT as an independent predictor of SIIH (odds ratio,
OR, 22.2; P = .007).
Conclusion
Abdominal pain patients with either SIIH or AMI are rare in the ED, but abdominal
CT sometimes cannot help to differentiate them due to similar CT findings. Prolonged
PT might help emergency physicians and surgeons differentiate SIIH from AMI in such
cases.
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Article Info
Publication History
Published online: September 18, 2013
Accepted:
August 9,
2013
Received in revised form:
August 8,
2013
Received:
April 15,
2013
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
