The recovery of intestine after ischaemic injury

Abstract

A reproducible model of reversible segmental ischaemia was used to evaluate methods of predicting intestinal viability after the release of strangulation. Visual assessment in the immediate period after reperfusion and at "second-look' 24 hours later was inaccurate in identifying recoverable bowel. A Doppler probe used to detect the return of pulsatile blood flow was overpredictive of necrosis. The pattern of surface fluorescence after injection of the supravital dye fluorescein increased the accuracy of predicting intestinal recovery. A series of silicone rubber injections was carried out to investigate whether the patency of the microvessels influenced the outcome. It was shown that as the ischaemic period increased there was progressive failure of the microcirculation. It was concluded that the fluorescein injection test correctly identifies recoverable bowel and that the outcome after ischaemic injury is related to microvascular patency.

Predicting the survival of experimental ischaemic small bowel using intraoperative near-infrared fluorescence angiography

“…Numerous techniques, including Doppler ultrasonography15, laser tissue blood flowmetry16, NIR spectroscopy17, charged‐couple device microscopy18, pulse oximetry19 and fluorescence angiography using fluorescein injection20, have been evaluated for clinical use during bowel surgery. Although fluorescein angiography was shown to be superior to Doppler ultrasonography21, 22, this optical technique is not currently used because visible fluorescence emission requires that all other operating room lights be off. Additionally, time to complete an examination was relatively long and repeat examination was hindered by fluorescein's long half‐life.…”

Laparoscopic evaluation of intestinal ischemia using fluorescein and ultraviolet light in a porcine model

“…However, the visual assessment of ischemic intestine under white light is unreliable in both open and laparoscopic conditions [3,7,11]. The adjuvant use of fluorescein dye has been shown to increase the sensitivity and specificity of clinical judgement alone in open laparotomies for intestinal ischemia, and it is more accurate than other operative means of diagnosis, such as Doppler flowmetry [1,2,6,7,10,14].…”

“…Fluorescein dye is inexpensive, readily available, and safe [2,5,7,11,12,18]. Gorey [6] reported a sensitivity of 96% and a specificity of 95% with the use of fluorescein fluorescence in open exploration for mesenteric ischemia in the rat model. Pearse et al [17] found similar results in the early assessment of intestinal ischemia in the canine model with a sensitivity of 88%.…”

Review of general surgery 1980

“…The remainder were viable by both tests and were preserved. Gorey (1980) revives interest in the use of fluorescein to define bowel viability and showed in rats that fluorescence was 95 % accurate in predicting viable and non-viable bowel.…”