Detection of Postoperative Intestinal Ischemia in Small Bowel Transplants

Abstract

Small bowel transplantation is acknowledged as auto- and allotransplantation. In both instances, there is up to a 4%–10% risk of postoperative ischemia, and as the small bowel is extremely susceptible to ischemia, the timely diagnosis of ischemia is important. The location of the transplant, whether it is buried in the abdominal cavity or in the neck region, increases the challenge, as monitoring becomes more difficult and the consequences of neglect more dangerous. All methods for the early detection of postoperative ischemia in small bowel transplants are described together with the requirements of the ideal monitoring method. A small bowel transplant can be inspected directly or indirectly; the blood flow can be monitored by Doppler or by photoplethysmography, and the consequences of the blood flow can be monitored. The ideal monitoring method should be reliable, fast, minimally invasive, safe, objective, easy, cheap, and comfortable. No monitoring methods today fulfill the criteria of the ideal monitoring method, and evidence-based guidelines regarding postoperative monitoring cannot be made. The choice of whether to implement monitoring of ischemia—and if so, which method to choose—has to be made by the individual surgeon or center.

Intraoperative measurement of bowel oxygen saturation using a multispectral imaging laparoscope

“…The blood supply to a surgically-treated organ is the key factor in determining how well it heals and whether or not normal function will be restored. Insufficient perfusion of oxygenated blood can result in ischaemia [1] and subsequent damage to the tissue. Creation of an anastomosis (surgical attachment of two luminal structures) in the gastrointestinal (GI) tract to restore continuity following tumour resection is one such example.…”

3D Printed Microfluidic Device with Integrated Biosensors for Online Analysis of Subcutaneous Human Microdialysate

“… 18 − 21 In particular, the lactate/glucose ratio has been shown to be an especially sensitive marker of tissue health, providing a clear indication as to whether tissue energy demands are being met. 16 , 19 , 22 …”

Enhanced Effect of IL-1β-Activated Adipose-Derived MSCs (ADMSCs) on Repair of Intestinal Ischemia-Reperfusion Injury via COX-2-PGE2 Signaling

“…Intestinal ischaemia and reperfusion (IR) is a common clinical problem that remains one of the leading causes of mortality in critically ill patients. Intestinal IR injury is a pathological process for a variety of diseases, like superior mesenteric artery (SMA) embolism, intestinal transplantation, radiation enteropathy, and sepsis [1][2][3]. It has been reported that mucosal barrier damage is prominent during intestinal IR process and leads to gut dysfunction, such as bacterial translocation and decreased nutrient absorption.…”