Cited by 203Abdominal vascular conditions and treatmentsIntestinal and Peritoneal AdhesionsGastrointestinal Bleeding Diagnosis and Treatment

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Intraoperative Determination of Small Intestinal Viability following Ischemic Injury: A Prospective, Controlled Trial of Two Adjuvant Methods (Doppler and Fluorescein) Compared with Standard Clinical Judgment

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BULKLEY, GREGORY B., ZUIDEMA, GEORGE D., HAMILTON, STANLEY R., OʼMARA, CHARLES S., KLACSMANN, PETER G., HORN, SUSAN D.·1981·Annals of Surgery

DOI 10.1097/00000658-198105000-00014PMC PMC1345136

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Abstract

Two adjuvant techniques for the intraoperative assessment of small intestinal viability were compared with standard clinical judgment in a prospective, controlled study of 71 ischemic bowel segments in 28 consecutive patients operated on for acute intestinal ischemic disease. Each segment was independently assessed 15 minutes after surgical correction of the underlying lesion by: 1) standard clinical judgment; 2) Doppler-detected pulsatile mural blood flow; and 3) fluorescein ultraviolet fluorescence pattern. Viability endpoint for each segment was determined objectively by patient follow-up or "blinded" microscopic evaluation of histologically unequivocal resection specimens using criteria established by previous animal studies. Seventeen histologically equivocal specimens were excluded from the final results. Standard clinical judgment proved moderately accurate overall (89%) but would have led to a relatively high rate (46%) of unnecessary bowel resection. The Doppler technique did not increase accuracy in any category of evaluation. The fluorescein fluorescent pattern was correct in all 54 determinant bowel segments, and proved more sensitive specific, predictive, and significantly more accurate overall than either standard clinical judgment or the Doppler method. This controlled study suggests that the fluorescein technique is the method of choice for the prediction of small intestinal recovery following ischemic injury.

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Authors: BULKLEY, G. B., ZUIDEMA, G. D., HAMILTON, S. R., OʼMARA, C. S., KLACSMANN, P. G., & HORN, S. D.
Affiliations: Johns Hopkins University (US)
ORCID: HAMILTON, STANLEY R.
HORN, SUSAN D.
Venue: Annals of Surgery
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1981-05
Volume: 193
Issue: 5
Pages: 628-637
ISSN: 0003-4932 (ISSN-L)
DOI: 10.1097/00000658-198105000-00014
PMC: PMC1345136
OpenAlex: W2049022052
Cited by: 203
References: 19
Citations by year: 2026: 3 · 2025: 6 · 2024: 6 · 2023: 6 · 2022: 7 · 2021: 11 · 2020: 6 · 2019: 4 · 2018: 7 · 2017: 7 · 2016: 3 · 2015: 3 · 2014: 5 · 2013: 3 · 2012: 5
FWCI: 6.15
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Annals of Surgery (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
Keywords: intestinal ischemia, intraoperative assessment, Doppler flow, bowel resection, histological evaluation
MeSH terms: Adolescent, Adult, Aged, Auscultation, Clinical Trials as Topic, Female, Humans, Intestine, Small, Intraoperative Period, Ischemia, Male, Middle Aged, Photofluorography, Prospective Studies, Ultrasonography

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Intraoperative Determination of Small Intestinal Viability following Ischemic Injury: A Prospective, Controlled Trial of Two Adjuvant Methods (Doppler and Fluorescein) Compared with Standard Clinical Judgment

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