Published: 2019-06-29

A prospective study of serum C-reactive protein and D-lactate levels for early prediction of strangulation in intestinal obstruction

Ramprasad Dhoon, Suresh Kumawat, M. L. Soni, M. K. Rohella, Sunil Sharma, Vinod Karosia, Rajesh Chahil


Background: Intestinal obstruction is one of the commonest clinical problems encountered in surgical practice. One of the grave complications of intestinal obstruction is strangulation, which requires an emergency laparotomy for management. This study was conducted to emphasise the significance of early estimation of rise in serum C-reactive protein and D- lactate levels.

Methods: Hospital based prospective study was performed on 50 patients admitted in J.L.N. Hospital, Ajmer in various surgical units with diagnosis of acute intestinal obstruction and underwent explorative Laparotomy.

Results: CRP test sensitivity was 85.00%, specificity was 80.67%, PPV was 73.91% and NPV was 88.89% to detected the obstruction with strangulation when using a cutoff value of 60 mg/L. D-lactate test sensitivity was 80.00%, specificity was 90.00%, PPV was 84.30% and NPV was 87.10% to detected the obstruction with strangulation when using a cutoff value of 4.5 mmol/L.

Conclusions:Serum CRP and D-lactate can be useful and reasonable markers for predicting strangulation in cases of acute intestinal obstruction in an emergency setting.



CRP, D-lactate, Intestinal obstruction

Full Text:



Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, et al. Acute mechanical bowel obstruct ion: clinical presentation, etiology, management and outcome. World J Gastroenterol. 2007;13(3):432-7.

Stolberg L, Rolfe R, Gitlin N, Merrit J, Mann L, Linder J. D-lactic acidosis due to abnormal flora. N Engl J Med. 1982;306(22):1344-8.

Perlmutter DH, Boyle JT, Campos JM, Egler JM, Watkins JB. D-lactic acidosis i n children: an unusual metabolic complication of small bowel resection. J Pediatr 1983;102(2):234-8.

Hilal K, Koçdor MA, Astarcioğlu H, Fadiloğlu M. Serum tumor necrosis factor-α, glutamate and lactate changes in two different stages of mechanical intestinal obstruction. Turk J Gastroenterol 2003;14(2):115-9.

Block T, Nilsson TK, Björck M, Acosta S. Diagnostic accuracy of plasma biomarkers for intestinal ischaemia. Scand J Clin Lab Invest. 2008;68(3):242-8.

Demir IE, Ceyhan GO, Friess H. Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia? Dig Surg. 2012;29(3):226-35.

Lin YP, Lee J, Chao HC, Kong MS, Lai MW, Chen CC, Chen SY, Luo CC. Risk factors for intestinal gangrene in children with small-bowel volvulus. Pediatr Gastroenterol Nutr. 2011;53(4):417-22.

Van Noord D, Mensink PB, de Knegt RJ, Ouwendijk M, Francke J, van Vuuren AJ, Hansen BE, Kuipers EJ. Serum markers and intestinal mucosal injury in chronic gastrointestinal ischemia. Dig Dis Sci. 2011;56(2):506-12.

Pal AK, Ansari MM, Islam N. Combination of Serum C – reactive protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction. Panam J Trauma Crit Care Emerg Surg. 2016;5(3):134-9.