Intraoperative contrast-enhanced sonography of bowel blood flow: preliminary experience.
OBJECTIVE
The potential to predict, and therefore avoid, anastomotic failure has eluded generations of colon and rectal surgeons to date. A reliable, reproducible method of assessing bowel blood flow therefore would be of enormous potential clinical relevance. To our knowledge, intraoperative contrast-enhanced sonography of the bowel has not been performed previously. We present our study assessing the feasibility of using contrast-enhanced sonography to study bowel perfusion intraoperatively.


METHODS
We studied 8 patients (4 male and 4 female) with an age range of 52 to 81 years who underwent colorectal surgery (right hemicolectomies, n = 3; Hartmann procedure, n = 1; anterior resections, n = 2; and bowel resections with ileocolic anastomoses, n = 2). A 5-mL bolus of a sulfur hexafluoride contrast agent solution was injected before and after vascular ligation with simultaneous noncompression ultrasound scanning directly over the large bowel. The patients were followed clinically to assess for leaks. Contrast-enhanced sonographic time-intensity curves were generated for the time to peak and maximum amplitude.


RESULTS
Moderate interobserver agreement was shown for the time to peak (κ = 0.50) and maximum amplitude (κ = 0.42), and moderate intraobserver agreement was shown for the time to peak (κ= 0.53) and maximum amplitude (κ= 0.53). No significant differences were shown between the time to peak (P = .28) and maximum amplitude (P = .49) for the preligation and postligation scans.


CONCLUSIONS
To our knowledge, intraoperative contrast-enhanced sonography of the bowel has not been performed previously. We have shown the technique to be feasible with good intraobserver and interobserver agreement. Further work is ongoing to optimize the technique and assess its use in predicting anastomotic breakdown.
Department of Radiology, Castle Hill Hospital, Hull and East Yorkshire Hospitals National Health Service Trust, Cottingham, East Yorkshire, England. andrewjamesswift@gmail.com
Andrew J
AJ
Swift
Pamela
P
Parker
Kieth
K
Chiu
Ian A
IA
Hunter
John E
JE
Hartley
Oliver R
OR
Byass
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003106:Colon / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007420:Intestine, Large / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000601:surgery; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D015588:Observer Variation; D010743:Phospholipids; D011446:Prospective Studies; D012007:Rectum / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D015203:Reproducibility of Results; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride