PMC3475002_01
Operative situs after second-look laparotomy. The proximal segment of the jejunum (80 cm) is slightly congested but appears to be vital (I); the congested distal segment of the jejunum and the ileum have a highly questionable viability (II and III). The transverse colon (IV) has a normal appearance. The resection of the whole bowel with questionable viability would probably lead to short bowel syndrome.
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fig1
Revision laparotomy due to septic condition one day after radical right hemicolectomy showed an extensive infarction of the small bowel in a fifty-one year old woman as seen in Figure 1.
Mean values (10 sec) of laser Doppler flowmetry (microvascular flow and erythrocyte velocity) and spectroscopy (microvascular haemoglobin oxygenation SO2 and microvascular haemoglobin concentration rHB) of the proximal segment of the jejunum (I), of the distal segment of the jejunum and the ileum (II and III), and of the transverse colon (IV). The mean values measured at the chosen cut margin are just in range of the critical threshold values. The resected segment of bowel (III) shows a microvascular flow value below the critical threshold value of 10 AU and a microvascular haemoglobin concentration rHB almost at the critical threshold value of 90 AU.
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fig2
Starting our measurements at the proximal part of the jejunum and proceeding stepwise towards the terminal ileum, we defined the cut margin just before the recommended threshold values were reached as seen in Figure 2.
The histologic examination shows a haemorrhagic ischemic necrosis of the mucosa of the smaller intestine with a transmural congestion (corresponding to segment III in the other figures). Only 5 mm of vital mucosa was left next to the cut margin.
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fig3