A critical analysis of adjuvant techniques used to assess bowel viability in acute mesenteric ischemia

Delayed revascularization and inaccurate assessment of bowel viability in acute mesenteric ischemia can be catastrophic. We reviewed the outcome of three popular adjuvant techniques used to evaluate bowel viability in all 16 patients who had second-look abdominal explorations following revascularization for acute mesenteric ischemia from 1984 to 1989. Each adjuvant technique was reviewed separately and compared with the unequivocal end points of viable or nonviable bowel. The sensitivity (percentage of nonviable bowel correctly identified), specificity (percentage of viable bowel identified), predictive value (percentage of bowel identified as "nonviable" that proved to be so), and overall accuracy (percentage of correct evaluations) were determined for each method. The overall accuracy of clinical judgment, fluorescein fluorescence, and Doppler was 50 per cent, 56 per cent, and 0 per cent, respectively. Based on this critical review, we recommend routine second-look explorations in patients with acute mesenteric ischemia to reassess bowel that has been predicted to be viable or to resect bowel that has progressed to infarction.