J Korean Soc Emerg Med.  2023 Aug;34(4):330-341.

Clinical differentiation between intestinal ischemia and acute gastroenteritis in the emergency department

• Kim U
• Ahn SB
• Lee JY

Abstract

Objective
This study aimed to identify predictive factors for suspected intestinal ischemia (II) when compared with those of acute gastroenteritis (AGE) in the emergency department (ED).
Methods
This single-center retrospective case-control study included 71 patients with II and 355 with AGE who visited the ED from 2014 to 2021. We attempted to compare the initial clinical presentation and laboratory examination findings of the II and AGE patients. The data in this study were analyzed using the chi-square test, Student t-test, and logistic regression analysis.
Results
The analyses showed that patients with II accounted for only about 0.018% of patients visiting the ED. The logistic regression analysis results revealed that age >51 years (odds ratio [OR], 9.75; 95% confidence interval [CI], 3.84-24.75), onset-to-visit time <48 hours (OR, 9.98; 95% CI, 2.47-40.31), lower abdominal pain (OR, 2.69; 95% CI, 1.10-6.61), hematochezia (OR, 28.53; 95% CI, 6.98-116.62), past medical history (PMHx) of atrial fibrillation (A-fib) (OR, 19.01; 95% CI, 1.26-286.97), hyperglycemia (OR, 3.06; 95% CI, 1.28-7.34), and hypoalbuminemia (OR, 11.75; 95% CI, 2.35-58.67) had high ORs, indicating a high probability of II, whereas diarrhea (OR, 0.24; 95% CI, 0.09-0.60), febrile feeling or chill (OR, 0.02; 95% CI, 0-0.16), and fever (OR, 0.05; 95% CI, 0.01-0.42) had low ORs, indicating a higher probability of AGE than II (P<0.05).
Conclusion
Intestinal ischemia should be suspected and contrast-enhanced computed tomography results should be taken into consideration if the patient’s age is >51 years; onset-to-visit time is <48 hours; symptoms of lower abdominal pain and hematochezia are present, there is PMHx of A-fib, hyperglycemia, and hypoalbuminemia; and diarrhea, febrile feeling/chill, and fever are absent.

Keyword

Mesenteric ischemia; Ischemic colitis; Gastroenteritis; Emergencies