title: Endoluminal pulse oximetry of the sigmoid colon and the monitoring of the colonic circulation.
abstract: Colonic ischaemia is a frequently observed serious complication following abdominal aortic reconstruction. For adequate treatment of this disorder, early diagnosis and resection of the diseased colon is essential. The purpose of this study was to evaluate a new method, based on pulse oximetry, to detect colonic ischaemia at an early preclinical stage. During a 7-year period (1989-1995) colonoscopy and pulse oximetry were performed in all patients at risk of colonic ischaemia: complicated acute or elective aortic reconstructions, colostomies with superficial necrosis and in patients who underwent uncomplicated aortic reconstruction and non-ischaemic colonic problems (n = 90). The sensitivity, specificity and positive predictive values, and negative predictive value, were calculated. All patients, except four for whom an acute relaparotomy was necessary, subsequently underwent colonoscopy combined with endoluminal pulse oximetry. Of the 90 patients, 30 had colonic ischaemia according to endoscopy (n = 26) or relaparotomy (n = 4), and in 33 patients the absence of pulsatile signal was detected by means of pulse oximetry. Thus, in three patients, pulse oximetry was falsely positive for colonic ischaemia. The calculated sensitivity and specificity of pulse oximetry were 100 and 95%, respectively. In comparison to other methods used for early detection of colonic ischaemia, pulse oximetry appears to be a promising method for the evaluation and monitoring of colonic ischaemia because it is non-invasive and easy to apply with a high sensitivity and specificity.
authors.affiliation: Department of Surgery, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: E N
authors.initials: EN
authors.lastname: Yilmaz
authors.forename: A C
authors.initials: AC
authors.lastname: Vahl
authors.forename: G
authors.initials: G
authors.lastname: van Rij
authors.forename: S H
authors.initials: SH
authors.lastname: Nauta
authors.forename: H L
authors.initials: HL
authors.lastname: Brom
authors.forename: J A
authors.initials: JA
authors.lastname: Rauwerda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D012809:Colon, Sigmoid / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008833:Microcirculation; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010092:Oximetry / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D012680:Sensitivity and Specificity; D012812:Sigmoidoscopy; D014656:Vascular Surgical Procedures / Q000009:adverse effects