Comparison of five methods of assessment of intestinal viability.
A strain gauge device called the electronic contractility meter (ECM) was designed to measure quantitatively intestinal ischemic damage by delivering electrical stimuli to the intestine. Threshold stimulus level (TSL) was the minimum stimulus in milliamps necessary to produce a smooth muscle contractile response. TSL scale ranged from zero to 100 milliamps. Resection and anastomosis in ischemic intestinal segments was carried out in 30 dogs to compare TSL, intestinal color, peristalsis, Doppler ultrasound and resection margin histology with survival. There were five fatal anastomotic leaks, all resulting from intestinal necrosis. Doppler pulse in the marginal artery (MA) was absent at four of the five anastomoses that leaked versus eight of the 25 that healed (p less than or equal to 0.01). Mean TSL at the resection site was 38 +/- 7 milliamps in surviving dogs versus 51 +/- 4 milliamps in nonsurvivors (p less than or equal to 0.001). Mean TSL of normal intestine was 22 +/- 2 milliamps. Both TSL and Doppler ultrasound also correlated with resection margin histology (p less than or equal to 0.02 and p less than or equal to 0.005, respectively). Presence of peristalsis did not correlate with histologic grade or survival rate. Intestinal color correlated with resection margin histology (p less than or equal to 0.001) but not survival. The ECM and Doppler ultrasound were both superior to gross visual assessment in predicting intestinal survival. The ECM quantitatively measures tissue damage, a potential advantage over Doppler ultrasound, which provides only an estimate of local arterial blood flow.
Brolin
R E
RE
Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903-0019.
Semmlow
J L
JL
Sehonanda
A
A
Koch
R A
RA
Reddell
M T
MT
Mast
B A
BA
Mackenzie
J W
JW
D000714:Anastomosis, Surgical; D000818:Animals; D001783:Blood Flow Velocity; D003116:Color; D004195:Disease Models, Animal; D004285:Dogs; D004558:Electric Stimulation / Q000295:instrumentation*; D004630:Emergencies; D005069:Evaluation Studies as Topic; D007082:Ileum / Q000098:blood supply*; D007511:Ischemia / Q000503:physiopathology* / Q000601:surgery; D009119:Muscle Contraction; D010528:Peristalsis; D012684:Sensory Thresholds; D013529:Surgical Wound Dehiscence / Q000209:etiology; D014463:Ultrasonography