The role of D-dimer in the diagnosis of strangulated small-bowel obstruction

Algirdas Boguševičius, Arūnas Grinkevičius, Almantas Maleckas, Juozas Pundzius

Department of Surgery, Kaunas University of Medicine, Lithuania

Key words: small-bowel obstruction; strangulated obstruction; diagnosis; D-dimer level.

Summary. Background. Various diagnostic utilities have been used in the diagnosis of strangulated obstruction. Despite this, there is no simple and reliable marker for it, and diagnosis in most cases is based on clinical, laboratory, and radiological investigations. The purpose of the present study was to assess D-dimer value in the diagnosis of strangulated obstruction.

Methods. A prospective study of 53 patients with small-bowel obstruction was conducted. Strangulated obstruction was present in 15 (28.3%) patients. Eight (53%) had intestinal necrosis, while 7 (47%) reversible ischemia. The blood samples were taken and analyzed with NycoCard Reader method with monoclonal antibodies specific for D-dimer neoantigens.

Results. In the presence of intestinal necrosis, there was a higher D-dimer level found than in the cases with reversible ischemia or simple small-bowel obstruction, although this difference did not reach statistically significant level. The D-dimer test had a sensitivity of 60%, specificity of 68%, positive predictive value of 43%, and negative predictive value of 81% in diagnosing strangulated obstruction.

Conclusion. In present series, D-dimer test was neither sensitive nor specific in diagnosing strangulation.

Correspondence to A. Boguševičius, Department of Surgery, Kaunas University of Medicine, Eivenių 2, 50009 Kaunas, Lithuania. E-mail: bogusas@yahoo.com

Received 20 November 2006, accepted 12 November 2007