Emergency laparoscopy
- 36 Downloads
- 3 Citations
Abstract
Background: Laparoscopic diagnosis of intestinal ischemia is difficult. Dark-colored bowels are not a reliable indicator for infarction, because there is no correlation between color and oxygenation. The same picture is produced by intraluminal blood or feces. False diagnoses are described.
Methods: We analyzed various techniques for assessing intestinal oxygenation and perfusion to support laparoscopic diagnosis.
In this study laparoscopy was performed on eight pigs. A 10-cm segment of intestine was fixed to the abdominal wall and rendered ischemic. Measurements of the ischemic segment and normal intestine were taken using laser-Doppler, Doppler ultrasound, spectrophotometer, and pulse oximeter. Doppler ultrasound and pulse oximetry were unsuitable in our model, as was laser-Doppler flowmetry.
Results: Only the spectrophotometer proved a highly sensitive means of assessing bowel oxygenation.
Conclusions: This method provides the desired additional information about intestinal oxygenation, thus helping to interpret the laparoscopic picture of dark bowels.
Key words
Intestinal ischemia Emergency laparoscopy Spectrophotometry Pulse oximetry Doppler-ultrasound Laser-DopplerPreview
Unable to display preview. Download preview PDF.
References
- 1.Barth K, Alderson P, Strandberg J (1978) 99m Tc-Pyrophosphate imaging in experimental mesenteric infarction: relationship of tracer uptake to the degree of ischemic injury. Radiology 129: 491–495Google Scholar
- 2.Berci G, Sackier JM, Paz-Partlow M (1991) Emergency laparoscopy. Am J Surg 161: 332–335Google Scholar
- 3.Bussemaker JB, Lindemann J (1972) Comparison of methods to determine viability of small intestine. Ann Surg 176: 97Google Scholar
- 4.Cooperman M (1983) Assessment of intestinal ischemia. In: Cooperman M (ed) Intestinal ischemia, Futura, Mount Kisco, NY, pp 129–150Google Scholar
- 5.DeNobile J, Guzzetta Ph, Patterson K (1990) Pulse oximetry as a means of assessing bowel viability. J Surg Res 48: 21–23Google Scholar
- 6.Eypasch E, Menningen R, Paul A, Troidl H (1993) Die Bedeutung der Laparoskopie bei der Diagnostik und Therapie des akuten Abdomens. Zentralbl Chir 118: 723–726Google Scholar
- 7.Ferrara JJ, Dyess DL, Lasecki M, Kinsey S, Donell C, Jurkovisch GJ (1988) Surface oximetry. A new method to evaluate intestinal perfusion. Am J Surg 54: 10–14Google Scholar
- 8.Iberti J, Salky B, Onefrey D (1989) Use of bedside laparoscopy to identify intestinal ischemia in postoperative cases of aortic reconstruction. Surgery 105: 686–689Google Scholar
- 9.Kam DM, Scheeres DE (1993) Fluorescein-assisted laparoscopy in the identification of arterial mesenteric ischemia. Surg Endosc 7: 75–78Google Scholar
- 10.Kasler M, Glaß Wv, Albrecht HP, Lang T (1990) Nicht invasive intraoperative Messung der intrakapillären Hämoglobinoxygenierung und relativen Hämoglobinkonzentration in Hautlappenplastiken. HNO 38: 375–378Google Scholar
- 11.Kleinhaus S, Sammartano R, Boley S (1978) Effects of laparoscopy on mesenteric blood flow. Arch Surg 113: 867–869Google Scholar
- 12.Kurland B, Brandt LJ, Delany HM (1992) Diagnostic tests for intestinal ischemia. Surg Clin North Am 72: 85–105Google Scholar
- 13.MacDonald PH, Dinda PK, Beck IT, Mercer CD (1993) The use of oximetry in determining intestinal blood flow. Surg Gynecol Obstet 176: 451–458Google Scholar
- 14.Mann A, Fazio VW, Lucas FV (1982) A comparative study of the use of fluorescein and the Doppler device in the determination of intestinal viability. Surg Gynecol Obstet 154: 53–55Google Scholar
- 15.Metzger A, Glättli A, Klaiber Ch (1995) Laparoskopie in der Notfallchirurgie. In: Pier A, Schippers E (eds) Minimal invasive chirurgie—Grundlagen, Technik, Ergebnisse, Trends. Thieme Verlag Stuttgart New York, pp 134–138Google Scholar
- 16.Nagy AG, James D (1989) Diagnostic laparoscopy. Am J Surg 157: 490–493Google Scholar
- 17.Oster Z, Sriviasta S, Som P (1989) Mesenteric vascular occlusion: a new diagnostic method using a radiolabeled monoclonal antibody. Radiology 171: 653–656Google Scholar
- 18.Poole J, Sammartano R, Boley S (1987) The use of tonometry in the early diagnosis of mesenteric ischemia. Curr Surg 44: 21–24Google Scholar
- 19.Siedler M (1992) Mikrolichtleiter-Spektrophotometrie als intraoperatives Testverfahren für Darmanastomosen, Dissertation der Friedrich-Alexander-Universität Erlangen, NürnbergGoogle Scholar
- 20.Yamaguchi T (1989) Continuous monitoring of gastroduodenal mucosal hemodynamics in rats by laser-Doppler flowmetry and reflectance spectrophotometry. Gastroenterol Jpn 24(6): 619–625Google Scholar