Techniques for intraoperative evaluation of bowel viability in mesenteric ischemia: A review

Bryski, Mitchell G.; Sulyok, Lydia G. Frenzel; Kaplan, Lewis J.; Singhal, Sunil; Keating, Jane

doi:10.1016/j.amjsurg.2020.01.042

Cited by 32 publications

(36 citation statements)

References 53 publications

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“…Indeed, the reperfusion time depends on the level of atherosclerosis, dehydration, and other comorbidities. In circumstances where bowel viability cannot be clearly ascertained due to extensive involvement of the superior mesenteric vein, a second look within 24-48 hours may be required [5].…”

Section: Discussionmentioning

confidence: 99%

Fifty Shadows of Mesenteric Ischemia

Pelizzo¹,

Sacchet²,

Grossi³

et al. 2021

SCR

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A 66-year-old female presented to the emergency department with sudden onset of central abdominal pain irradiated to the back. Blood tests were unremarkable. Computed tomography scan showed acute focal ischaemia of small bowel loops sustained by an encircling omental band around a mid ileal loop, which was released on urgent mini-laparotomy. The ischaemic loops were covered with hot moist gauzes for several minutes until the normal luster and peristaltic wave returned. Indocyanine green fluorescence angiography confirmed sufficient bowel perfusion and viability. The patient was discharged 5 days after surgery and did not experience any symptom recurrence up to 6 months later. Mesenteric or colonic ischaemia may respectively affect the small or large intestine. The small intestine is able to compensate for a 75% reduction in mesenteric perfusion for up to 12 hours. If promptly treated, resection may be successfully avoided.

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Section: Discussionmentioning

confidence: 99%

Fifty Shadows of Mesenteric Ischemia

Pelizzo¹,

Sacchet²,

Grossi³

et al. 2021

SCR

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“…All patients underwent exploratory laparotomy by performing a midline incision to explore the abdominal cavity and certify the diagnosis. The decision for intestinal resection was determined intraoperatively considering the aspect of the intestines [10]. We categorize our patients into two groups based on their diagnoses.…”

Section: Methodsmentioning

confidence: 99%

The Utility of Biomarkers in Diagnosing and Predicting Outcomes in Acute Mesenteric Ischemia

Pirvu

Bratosin

Nica

et al. 2021

Surgery

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Background: Acute intestinal ischemia stands as the most lethal acute condition encountered by general surgeons and one of the deadliest pathologies in medicine triggered by thromboembolic events. The patients’ survival decreases dramatically to a lower than 30% rate when diagnosed after 24 hours, thus early diagnosis with proper surgical or vascular intervention is mandatory. This study aims to determine the utility of biomarkers and routine blood tests in assessing the severity and mortality risk for patients with acute mesenteric ischemia. Methods: The study was developed on a prospective cross-sectional design over a period of five years, finding a total of 147 patients who underwent emergency surgery after a high suspicion of acute mesenteric ischemia. The available biomarkers used in our Clinic comprised a complete blood count, total bilirubin, CK, CK-MB, LDH, AST, ALT, amylase, and cholinesterase. Results: The leukocyte count (OR=1.105), hemoglobin (OR=3.912), LDH (OR=1.144), NLR (OR=1.154), and LLR (OR=1.286) were all independent and significant risk factors for AMI diagnosis. These covariates proved a good and reliable tool for diagnosing AMI with a 75.3% predicted probability. Conclusion: The prediction tool proved reliable, although it should only be considered in the clinical context where the surgeon suspects a case of acute mesenteric ischemia. The proposed model should be further investigated and validated in larger studies.

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“…Among the methods that allow intraoperative visualization of microcirculation, the most common one is fluorescence imaging with the indocyanine green as a fluorophore [12][13][14]. Tissue perfusion can be assessed using laser Doppler flowmetry [15,16], laser speckle contrast imaging (LSCI) [17,18], sidestream dark field (SDF) microscopy [19,20], incident dark field (IDF) microscopy [21], and hyperspectral imaging (HSI) [22].…”

Section: Introductionmentioning

confidence: 99%

“…Tissue perfusion can be assessed using laser Doppler flowmetry [15,16], laser speckle contrast imaging (LSCI) [17,18], sidestream dark field (SDF) microscopy [19,20], incident dark field (IDF) microscopy [21], and hyperspectral imaging (HSI) [22]. However, all the above methods are capable of assessing only the microcirculatory component of the intestinal wall (and in most cases, from the organ surface), allowing the measurement of tissue oxygenation or blood flow, but they do not provide information on structural tissue damage/necrosis [14]. The inability to directly visualize morphological changes in ischemic tissues is a significant drawback of the methods mentioned above.…”

Section: Introductionmentioning

confidence: 99%

Effect of Surgical Technique on the Microstructure and Microcirculation of the Small Intestine Stump during Delayed Anastomosis: Multimodal OCT Data

Kiseleva¹,

Ryabkov

Sizov

et al. 2021

Sovrem Tehnol Med

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The aim of the study was to use multimodal optical coherence tomography (MM OCT) to evaluate microstructure and microcirculation in the proximal and distal sections of the intestine relative to the resected area in acute mesenteric ischemia.Materials and Methods. The study was carried out using three groups of male Wistar rats weighing 270-435 g (n=18). Acute occlusive arterial ischemia of the small intestine was initiated in all animals. After 80-90 min, the ischemic non-viable part of the intestine was resected, and the operation was completed by stoma exteriorization (group 1, n=6), by applying purse-string sutures (group 2, obstructive resection, n=6), or by internal drainage of the proximal and distal ends of the small intestine (group 3, bypass, n=6). Relaparotomy and anastomosis formation were performed 2 days later.With the help of MM OCT at each stage of the surgical intervention, images were obtained from the serous membrane side: the intestinal wall microstructure (layers) was viewed using cross-polarization OCT (CP OCT) and the intramural circulation -using optical coherent angiography (OCA). The MM OCT images obtained from the terminal intestine sections immediately after resection and 2 days later (before the anastomosis formation) were compared between the experimental groups, as well as with the pre-ischemic data (norm). All resected sections of the intestine were then histologically examined. The MM OCT data were compared with the histological and intravital macroscopy data.Results. As a result of studying the intestinal wall microstructure by in vivo CP OCT, it was found that during ostomy (group 1) and obstructive resection (group 2), the images showed signs of tissue edema and destructive changes in the mucous membrane that were confirmed histologically, while with bypass surgery (group 3), there were minimal changes as compared with the norm.According to the OCA data, on day 2 of ostomy in the proximal and distal segments of the intestine, there was a noticeable disappearance of small and medium blood vessels; mainly large arteries and veins could be visualized. Following obstructive resection (purse-string suturing) or bypass surgery, the most noticeable changes (a decrease in the number of visualized blood vessels) were observed in the distal part of the intestine. The L index calculated from OCA images and characterizing the total length of the intramural perfused vasculature, showed a statistically significant decrease during ostomy: 12.18 [10.40; 14.20] µm -in the proximal and 10.67 [7.98; 13.05] µm -in the distal section; for comparison, the L index before ischemia was 18. 90 [17.98; 19.73] μm and 18.74 [17.46; 19.90] μm, respectively (p=0.0001). In obstructive resection (group 2), statistically significant differences in the L parameter were found only for the distal bowel section: 16.39 [12.37; 18.10] µm compared with 18.74 [17.46; 19.90] μm before ischemia (p=0.041). After bypass surgery (group 3), there were no significant deviations in the L index.Conclusion. By using MM OCT, we ...

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Techniques for intraoperative evaluation of bowel viability in mesenteric ischemia: A review

Cited by 32 publications

References 53 publications

Fifty Shadows of Mesenteric Ischemia

Fifty Shadows of Mesenteric Ischemia

The Utility of Biomarkers in Diagnosing and Predicting Outcomes in Acute Mesenteric Ischemia

Effect of Surgical Technique on the Microstructure and Microcirculation of the Small Intestine Stump during Delayed Anastomosis: Multimodal OCT Data

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