Gastric intramucosal pH as a monitor of gut perfusion after thrombosis of the superior mesenteric vein.
Gastric intramucosal pH (pHi) when measured by a tonometer is a simple and minimally invasive method to determine gut ischemia. In a case of severe mesenteric venous thrombosis, we measured pHi intra- and postoperatively over a period of five days. The goal was to monitor improvement or deterioration of gastrointestinal perfusion in the intensive care unit and to perform a second-look laparotomy if the condition worsened. We observed that gastric pHi is a more sensitive parameter for detecting intestinal ischemia than parameters such as arterial pH, base excess, or lactate. This patient's pHi rose continuously, which allowed us to proceed in a conservative way without any further invasive diagnostic interventions. Thus, the application of a gastric tonometer in cases of mesenteric venous thrombosis may help to reduce costs by preventing unnecessary postoperative diagnostic maneuvers such as angiography, computed tomography, or even second-look laparotomy.
Ruettimann
U
U
Department of Anesthesia, University of Basel Kantonsspital, Switzerland.
Urwyler
A
A
Von Flue
M
M
Reinhardt
D
D
Pargger
H
H
D000137:Acid-Base Imbalance / Q000097:blood; D000138:Acidosis / Q000097:blood; D000328:Adult; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007421:Intestine, Small / Q000098:blood supply* / Q000503:physiopathology; D007511:Ischemia / Q000175:diagnosis*; D007773:Lactates / Q000097:blood; D008297:Male; D008365:Manometry; D008641:Mesenteric Vascular Occlusion / Q000503:physiopathology*; D008642:Mesenteric Veins / Q000503:physiopathology*; D012039:Regional Blood Flow / Q000502:physiology; D020246:Venous Thrombosis / Q000503:physiopathology*
D007773:Lactates