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How to differentiate spontaneous intramural intestinal hemorrhage from acute mesenteric ischemia

  • Chia-Ying Tseng
    Affiliations
    Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan

    Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei 112, Taiwan
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  • Yu-Hui Chiu
    Affiliations
    Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei 112, Taiwan

    Department of Emergency Medicine, Wan-Fan Hospital, Taipei Medical University, Taipei 116, Taiwan
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  • Jui-Ling Chuang
    Affiliations
    Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 112, Taiwan
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  • Jen-Dar Chen
    Affiliations
    Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei 112, Taiwan

    Department of Radiology, Taipei City Hospital, Taipei 115, Taiwan
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  • Hsien-Hao Huang
    Correspondence
    Corresponding authors. Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C. Tel.: +886 2 875 7377; fax: +886 2 875 7842.
    Affiliations
    Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei 112, Taiwan

    Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan

    Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang-Ming University, Taipei 112, Taiwan
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  • Chorng-Kuang How
    Affiliations
    Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei 112, Taiwan

    Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan

    Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang-Ming University, Taipei 112, Taiwan
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  • David Hung-Tsang Yen
    Correspondence
    Corresponding authors. Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C. Tel.: +886 2 875 7377; fax: +886 2 875 7842.
    Affiliations
    Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei 112, Taiwan

    Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan

    Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang-Ming University, Taipei 112, Taiwan
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  • Mu-Shun Huang
    Affiliations
    Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei 112, Taiwan

    Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
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Published:September 18, 2013DOI:https://doi.org/10.1016/j.ajem.2013.08.009

      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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