1 3 DOI 10.1007/s00068-017-0805-7 Eur J Trauma Emerg Surg ORIGINAL ARTICLE Diagnostic value of arterial blood gas lactate concentration in the different forms of mesenteric ischemia A. Brillantino 1 · F. Iacobellis 2 · A. Renzi 3 · R. Nasti 1 · L. Saldamarco 1 · M. Grillo 4 · L. Romano 5 · M. Castriconi 4 · A. Cittadini 6 · M. De Palma 4 · M. Scaglione 7,8 · N. Di Martino 9 · R. Grassi 2 · F. Paladino 1 Received: 16 January 2017 / Accepted: 29 May 2017 © Springer-Verlag Berlin Heidelberg 2017 arterial blood gas and contrast enhanced abdominal com- puter tomography (CT). Results At CT, 201 patients (70.7%) showed a noni- schemic disease (group 1) and 83 patients (29.2%) showed findings of mesenteric ischemia. Out of these, 35 patients (42.1%) showed bowel ischemia secondary to non vascular causes (group 2) and 48 (57.8%) had a vascular intestinal ischemia (group 3). Out of these, 20 showed small bowel arterial occlusion (group 3a), 13 a small bowel nonocclusive ischemia (group 3b), 7 a venous small bowel occlusion (group 3c) and 8 showed isolated colonic ischemia (group 3d). The median lac- tate serum level was significantly higher in patients with vascular ischemia if compared with patients with noni- schemic disease and secondary mesenteric ischemia (p < 0.0001; Kruskal–Wallis test). The areas under ROC curves for the lactate serum levels in the groups 2, 3, 3a, 3b, 3c and 3d were, respectively, 0.61, 0.85, 0.93, 0.93, 0.68 and 0.67. Conclusions Arterial blood gas lactate levels seem to show good diagnostic accuracy in diagnosing small bowel arte- rial and nonocclusive ischemia and poor accuracy in diag- nosing secondary mesenteric ischemia, small bowel venous ischemia and ischemic colitis. Keywords Intestinal infarction · Bowel ischemia · Mesenteric ischemia · Ischemic colitis · Lactate · Arterial blood gas Abbreviations AMI Acute mesenteric ischemia ABG Arterial blood gas CT Computer tomography Abstract Purpose The role of serum lactate measurement in patients with intestinal ischemia still remains unclear. The aim of this study was to prospectively evaluate the diagnostic per- formance of arterial blood gas lactate concentrations in the patients with acute mesenteric ischemia and its different forms. Methods All the patients reporting abdominal pain associ- ated with risk factors for mesenteric ischemia underwent A. Brillantino and F. Iacobellis contributed equally to this work. * A. Brillantino antonio_brillantino@libero.it 1 Emergency Department “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy 2 Department of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy 3 Pelvic Care Center, “Villa delle Querce” Hospital, Via B. Caracciolo 48, Naples, Italy 4 Department of Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy 5 Department of Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy 6 Department of Medical Translational Sciences, University “Federico II”, Via Pansini 5, 80131 Naples, Italy 7 Department of Diagnostic Imaging, “Pineta Grande” Hospital, Via Domitiana Km 30.000, 81030 Castel Volturno, CE, Italy 8 Department of Radiology, University Hospitals of North Midlands, Newcastle Rd, Stoke-on-Trent ST4 6QG, UK 9 Department of Surgery, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy