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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

Mean values (10 sec) of laser Doppler flowmetry (microvascular flow and erythrocyte velocity) and spectroscopy (microvascular haemoglobin oxygenation SO2 and microvascular haemoglobin concentration rHB) of the proximal segment of the jejunum (I), of the distal segment of the jejunum and the ileum (II and III), and of the transverse colon (IV). The mean values measured at the chosen cut margin are just in range of the critical threshold values. The resected segment of bowel (III) shows a microvascular flow value below the critical threshold value of 10 AU and a microvascular haemoglobin concentration rHB almost at the critical threshold value of 90 AU.
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fig2: Mean values (10 sec) of laser Doppler flowmetry (microvascular flow and erythrocyte velocity) and spectroscopy (microvascular haemoglobin oxygenation SO2 and microvascular haemoglobin concentration rHB) of the proximal segment of the jejunum (I), of the distal segment of the jejunum and the ileum (II and III), and of the transverse colon (IV). The mean values measured at the chosen cut margin are just in range of the critical threshold values. The resected segment of bowel (III) shows a microvascular flow value below the critical threshold value of 10 AU and a microvascular haemoglobin concentration rHB almost at the critical threshold value of 90 AU.

Mentions: Starting our measurements at the proximal part of the jejunum and proceeding stepwise towards the terminal ileum, we defined the cut margin just before the recommended threshold values were reached as seen in Figure 2. The viable colon was used for reference measurement. Instead of 80 cm we could preserve 190 cm of small bowel. A split stoma was constructed to avoid primary anastomosis.


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)

Mean values (10 sec) of laser Doppler flowmetry (microvascular flow and erythrocyte velocity) and spectroscopy (microvascular haemoglobin oxygenation SO2 and microvascular haemoglobin concentration rHB) of the proximal segment of the jejunum (I), of the distal segment of the jejunum and the ileum (II and III), and of the transverse colon (IV). The mean values measured at the chosen cut margin are just in range of the critical threshold values. The resected segment of bowel (III) shows a microvascular flow value below the critical threshold value of 10 AU and a microvascular haemoglobin concentration rHB almost at the critical threshold value of 90 AU.
© Copyright Policy
Related In: Results  -  Collection

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

fig2: Mean values (10 sec) of laser Doppler flowmetry (microvascular flow and erythrocyte velocity) and spectroscopy (microvascular haemoglobin oxygenation SO2 and microvascular haemoglobin concentration rHB) of the proximal segment of the jejunum (I), of the distal segment of the jejunum and the ileum (II and III), and of the transverse colon (IV). The mean values measured at the chosen cut margin are just in range of the critical threshold values. The resected segment of bowel (III) shows a microvascular flow value below the critical threshold value of 10 AU and a microvascular haemoglobin concentration rHB almost at the critical threshold value of 90 AU.
Mentions: Starting our measurements at the proximal part of the jejunum and proceeding stepwise towards the terminal ileum, we defined the cut margin just before the recommended threshold values were reached as seen in Figure 2. The viable colon was used for reference measurement. Instead of 80 cm we could preserve 190 cm of small bowel. A split stoma was constructed to avoid primary anastomosis.

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