Use of Doppler ultrasound in intestinal surgery

Doppler ultrasonography was used intraoperatively in 117 patients undergoing intestinal anastomosis or enterostomy to determine the adequacy of blood supply at the margins of resection. Doppler findings were compared with clinical assessment of intestinal blood flow by the operating surgeon. In 92 per cent of cases, Doppler signals and clinical observation coincided. However, in five of six cases in which Doppler signals were absent at one margin, the surgeon resected additional intestine, selecting margins within 1 cm of the nearest arterial Doppler signal. All five patients had uneventful healing. In the one case in which the surgeon chose to rely onthe appearance of the bowel despite the absence of Doppler arterial signals, ischemic necrosis of the proximal segment and anastomotic disruption occurred. The technique of Doppler ultrasonography is readily learned, and the instrument is available in most hospitals. Intraoperative use of Doppler ultrasonography can help identify intestine lacking a blood supply adequate to assure viability before changes in the appearance of the bowel alert the surgeon to the problem.