He died 13 days after admission. Discussion Although some biomarkers like lactate and C-reactive protein can be useful in the diagnosis of an acute abdomen, these cases demonstrate
that these parameters can mislead the physician and contribute to more diagnostic examinations or unnecessary invasive interventions like a laparotomy. As described in all cases the main suspicion was acute mesenteric ischemia. This is a complex disease with a high mortality rate . Until now, no reliable parameters to help diagnose such serious disease have been found and a search to identify this factor continues. One of the markers that are frequently used is plasma lactate concentration. An increase of lactate levels indicates an anaerobe glucogenesis and therefore it is a parameter for inadequate perfusion, oxygenation and an estimate Erlotinib in vitro of tissue oxygen deficiency. Increased plasma lactate concentrations were observed in patients with mesenteric ischemia with a sensitivity of 100% and a specificity of 42% . Yet, another study on patient with an acute abdomen and increased lactate levels in the ED, showed a sensitivity of 75% and specificity 39% when using lactate concentrations for the diagnosis of acute mesenteric ischemia
. On the other hand the study of Lange et. al.  showed that elevation in lactate concentration can be due to other conditions as Venetoclax manufacturer well. For example general bacterial peritonitis and in about 50% of the cases with strangulated intestinal obstructions . Furthermore, other conditions correlated with high lactate concentrations are (septic) shock, diabetic ketoacidosis, liver coma, renal failure and acute pancreatitis. When other conditions have been excluded, an increased lactate level often may indicate an
emergency abdominal condition. Some authors recommend an laparotomy in all patients with abdominal complaints and a raised plasma lactate level when other conditions correlated with increased lactate levels have been excluded . However, we believe that this matter is more subtle as we observe that lactate levels are being for used as a parameter only for acute mesenterial ischemia. Our third case is an example of a patient without abdominal pain but with high lactate levels, probably due to liver failure. Based on the lactate levels, an unnecessary invasive diagnostic intervention, a laparotomy was performed. As a study concluded, the determination of lactate concentrations has no better sensitivity in establishing the diagnosis of patient with acute abdomen compared to clinical findings and normal laboratory examination . Another biomarker often used in the emergency department to aid in the diagnosis of an acute abdomen is the C-reactive protein (CRP). Most studies have focused mainly on the use of this parameter in establishing the diagnosis of appendicitis.