Intraoperative prediction of ischaemic injury of the bowel: a comparison of laser Doppler flowmetry and tissue oximetry to histological analysis.
Intraoperative diagnosis of inadequate colonic perfusion would contribute to prevention of ischaemic colitis after abdominal aortic reconstructions. The aim of this study was to evaluate laser Doppler flowmetry (LDF) and tissue oximetry (TpO2) as predictors of the development of bowel necrosis. Devascularised loops of colon and ileum in anaesthetised pigs were divided into 10-20 mm segments and measurements of laser Doppler flux and TpO2 were performed in each segment. After 7 h of ischaemia the segments were resected for histological and biochemical analysis. In 65 colonic and 58 ileal segments a significantly lower flux was found in segments with necrosis of greater than or equal to 30% of the mucosal thickness compared to segments with necrosis of less than or equal to 10% (p less than 0.01). The discriminant flux value was 50 perfusion units, confirming a previous clinical study. The specificity was 0.96 and the sensitivity 0.94. Flux was inversely correlated to tissue lactate concentration. Significantly lower TpO2 was found in 19 colonic segments with necrosis of greater than or equal to 30% of mucosa compared to 19 colonic segments with necrosis of less than or equal to 10% (p less than 0.01). Using a discriminant value of 5kPa, a specificity of 0.79, and a sensitivity of 0.95 were calculated. In 27 ileum segments no significant difference in TpO2 between different histological groups was found (p greater than 0.30). The results show that LDF and TpO2 can predict ischaemic injury of the colon, and LDF also of the small bowel.
Krohg-Sørensen
K
K
Unit of Vascular Surgery, Aker Hospital, Oslo.
Line
P D
PD
Haaland
T
T
Horn
R S
RS
Kvernebo
K
K
D000818:Animals; D003106:Colon / Q000098:blood supply / Q000473:pathology; D005069:Evaluation Studies as Topic; D007082:Ileum / Q000098:blood supply / Q000473:pathology; D007413:Intestinal Mucosa / Q000473:pathology; D007422:Intestines / Q000098:blood supply* / Q000473:pathology; D007432:Intraoperative Period; D007511:Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D017078:Laser-Doppler Flowmetry; D009336:Necrosis; D010092:Oximetry; D012680:Sensitivity and Specificity; D013552:Swine; D014463:Ultrasonography