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Venous small bowel infarction: intraoperative laser Doppler flowmetry discriminates critical blood supply and spares bowel length.

Käser SA, Glauser PM, Maurer CA - Case Rep Med (2012)

Bottom Line: The pathological examination showed only 5 mm of vital mucosa to be left distal to the dissection margin.No further interventions were necessary.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Liestal, University of Basel, 4410 Liestal, Switzerland.

ABSTRACT
Introduction. In mesenteric infarction due to arterial occlusion, laser Doppler flowmetry and spectrometry are known reliable noninvasive methods for measuring microvascular blood flow and oxygen utilisation. Case Presentation. As an innovation we used these methods in a patient with acute extensive mesenteric infarction due to venous occlusion, occurring after radical right hemicolectomy. Aiming to avoid short bowel syndrome, we spared additional 110 cm of small bowel, instead of leaving only 80 centimetres of clinically viable small bowel in situ. The pathological examination showed only 5 mm of vital mucosa to be left distal to the dissection margin. No further interventions were necessary. Conclusion. Laser doppler flowmetry and spectrometry are potentially powerful methods to assist the surgeon's decision-making in critical venous mesenteric perfusion, thus having an important impact on clinical outcome.

No MeSH data available.


Related in: MedlinePlus

Operative situs after second-look laparotomy. The proximal segment of the jejunum (80 cm) is slightly congested but appears to be vital (I); the congested distal segment of the jejunum and the ileum have a highly questionable viability (II and III). The transverse colon (IV) has a normal appearance. The resection of the whole bowel with questionable viability would probably lead to short bowel syndrome.
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fig1: Operative situs after second-look laparotomy. The proximal segment of the jejunum (80 cm) is slightly congested but appears to be vital (I); the congested distal segment of the jejunum and the ileum have a highly questionable viability (II and III). The transverse colon (IV) has a normal appearance. The resection of the whole bowel with questionable viability would probably lead to short bowel syndrome.

Mentions: Revision laparotomy due to septic condition one day after radical right hemicolectomy showed an extensive infarction of the small bowel in a fifty-one year old woman as seen in Figure 1. She had mesenteric venous thrombosis involving the ileum and the jejunum probably due to compromised blood flow in the superior mesenteric vein. The proximal part of the jejunum of about 80 cm (segment I), was slightly congested but appeared to be vital. The other part of the smaller intestine up to the ileocolic anastomosis (segments II and III) was congested and viability was highly questionable. The colon (segment IV) looked normal. Aiming to avoid short bowel syndrome, we decided to use LDF and spectrometry to save as much bowel as possible (O2C device, LF-2 probe, LEA Medizintechnik GmbH, Germany).


Venous small bowel infarction: intraoperative laser Doppler flowmetry discriminates critical blood supply and spares bowel length.

Käser SA, Glauser PM, Maurer CA - Case Rep Med (2012)

Operative situs after second-look laparotomy. The proximal segment of the jejunum (80 cm) is slightly congested but appears to be vital (I); the congested distal segment of the jejunum and the ileum have a highly questionable viability (II and III). The transverse colon (IV) has a normal appearance. The resection of the whole bowel with questionable viability would probably lead to short bowel syndrome.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475002&req=5

fig1: Operative situs after second-look laparotomy. The proximal segment of the jejunum (80 cm) is slightly congested but appears to be vital (I); the congested distal segment of the jejunum and the ileum have a highly questionable viability (II and III). The transverse colon (IV) has a normal appearance. The resection of the whole bowel with questionable viability would probably lead to short bowel syndrome.
Mentions: Revision laparotomy due to septic condition one day after radical right hemicolectomy showed an extensive infarction of the small bowel in a fifty-one year old woman as seen in Figure 1. She had mesenteric venous thrombosis involving the ileum and the jejunum probably due to compromised blood flow in the superior mesenteric vein. The proximal part of the jejunum of about 80 cm (segment I), was slightly congested but appeared to be vital. The other part of the smaller intestine up to the ileocolic anastomosis (segments II and III) was congested and viability was highly questionable. The colon (segment IV) looked normal. Aiming to avoid short bowel syndrome, we decided to use LDF and spectrometry to save as much bowel as possible (O2C device, LF-2 probe, LEA Medizintechnik GmbH, Germany).

Bottom Line: The pathological examination showed only 5 mm of vital mucosa to be left distal to the dissection margin.No further interventions were necessary.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Liestal, University of Basel, 4410 Liestal, Switzerland.

ABSTRACT
Introduction. In mesenteric infarction due to arterial occlusion, laser Doppler flowmetry and spectrometry are known reliable noninvasive methods for measuring microvascular blood flow and oxygen utilisation. Case Presentation. As an innovation we used these methods in a patient with acute extensive mesenteric infarction due to venous occlusion, occurring after radical right hemicolectomy. Aiming to avoid short bowel syndrome, we spared additional 110 cm of small bowel, instead of leaving only 80 centimetres of clinically viable small bowel in situ. The pathological examination showed only 5 mm of vital mucosa to be left distal to the dissection margin. No further interventions were necessary. Conclusion. Laser doppler flowmetry and spectrometry are potentially powerful methods to assist the surgeon's decision-making in critical venous mesenteric perfusion, thus having an important impact on clinical outcome.

No MeSH data available.


Related in: MedlinePlus