Effectiveness of Diagnostic Paracentesis for Suspected Strangulation Obstruction
Shin Kobayashi1, Kenji Matsuura2, Kazuhide Matsushima2; 1Surgery, Okinawa Yaeyama Hospital, Ishigaki, Japan; 2Surgery, Okinawa Chubu Hospital, Okinawa, Japan
SUMMARY BACKGROUND DATA; Strangulation obstruction is surgical emergency, but its accurate diagnosis and timely surgical treatment are still a matter of debate. We have prospectively analyzed our cases with suspected strangulation obstruction to see whether our diagnostic paracentesis under ultrasound is effective for the timely diagnosis. METHOD; We have prospectively examined the case collection with suspected strangulation obstruction. Diagnostic paracentesis under ultrasound was performed preoperatively if possible and ascites at the time of incision was obtained if paracentesis was impossible. Then, it was examined whether ascites color and laboratory parameters could be reliable indicators of strangulation. RESULTS; During 18 months of study period, 32 patients were suspected of strangulation preoperatively by history, physical exams, and radiographic imaging, and had their ascites obtained either by paracentesis or at laparotomy. Among those 32 patients, strangulation obstruction was confirmed at laparotomy for 21 patients, 2 patients had simple obstruction, 1 patient had non-therapeutic laparotomy for pseudoobstruction, and 7 patients were treated conservatively. Asites hematocrit, red blood cell, and lactate are identified as indicators to predict strangulation obstruction by univariate study (TABLE), and hematocrit and RBC sufficiently predicted strangulation by multivariate study. Ascites hematocrit above 0.3% predicted strangulation at 93.3%, and if it was over 0.4%, bowel resection was highly necessary. CONCLUSIONS; Paracentesis under ultrasound guidance is an easy and useful technique for diagnosis of strangulation obstruction, which is highly predicted with ascites hematocrit above 0.3%. All false negative cases were diagnosed to be strangulation by unequivocal clinical findings. Careful physical exams and paracentesis for equivocal physical findings enable early diagnosis of strangulation obstruction.
Correlation between laboratory parameters and strangulation.
| Strangulation | | Non-strangulation | | P value* |
parameters | Mean | S.D.** | Mean | S.D.** | |
RBC (x 104 / mm3) | 12.35 | 16.30 | 2.75 | 5.82 | < 0.05 |
Ht (%) | 0.89 | 1.01 | 0.25 | 0.59 | < 0.05 |
WBC (x 103 / mm3) | 1.84 | 3.63 | 2.90 | 7.56 | 0.30 |
Lactate (mmol / L) | 4.26 | 3.88 | 1.73 | 0.91 | < 0.05 |
pH | 7.39 | 0.32 | 7.42 | 0.12 | 0.43 |
B.E. (mEq/L) | 1.02 | 8.24 | 3.60 | 3.15 | 0.28 |
ALP (IU/L) | 264.6 | 284.7 | 168.7 | 184.7 | 0.17 |
LDH (IU/L) | 772.7 | 1061.3 | 439.2 | 633.3 | 0.18 |
Amy (IU/L) | 83.0 | 182.3 | 48.7 | 32.1 | 0.28 |
D-Bil (IU/L) | 0.19 | 0.14 | 0.14 | 0.05 | 0.14 |
* P value was calculated by unpaired t-test ** S.D.; standard deviation
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