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Emergency laparoscopy. Technical support for the laparoscopic diagnosis of intestinal ischemia
U Matern1, J Haberstroh, A el Saman
1Department of General Surgery, University Hospital, Freiburg, Germany.
Background:
Laparoscopic diagnosis of intestinal ischemia is difficult. Dark-colored bowels are not a reliable indicator for infarction, because there is no correlation between color and oxygenation. The same picture is produced by intraluminal blood or feces. False diagnoses are described.
Methods:
We analyzed various techniques for assessing intestinal oxygenation and perfusion to support laparoscopic diagnosis. In this study laparoscopy was performed on eight pigs. A 10-cm segment of intestine was fixed to the abdominal wall and rendered ischemic. Measurements of the ischemic segment and normal intestine were taken using laser-Doppler, Doppler ultrasound, spectrophotometer, and pulse oximeter. Doppler ultrasound and pulse oximetry were unsuitable in our model, as was laser-Doppler flowmetry.
Results:
Only the spectrophotometer proved a highly sensitive means of assessing bowel oxygenation.
Conclusions:
This method provides the desired additional information about intestinal oxygenation, thus helping to interpret the laparoscopic picture of dark bowels.