J.Jpn. Surg. Soc.. 91(9): 1446-1449, 1990

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Report on the annual meeting

DIAGNOSIS AND TREATMENT OF INTESTINAL ISCHEMIC LESIONS DEPENDING UPON THEIR PATHOPHYSIOLOGY

During the past 10 years, 26 cases of intestinal ischemic lesions have been experienced, including 6 cases of superior mesenteric arterial obstruction, 5 cases of major colonic arterial obstruction, one case of A pattern obstruction, 4 cases of obstruction of vasa recta, and 2 cases of non-occlusive intestinal ischemia. Among 26 cases, 18 cases were operated, of which 8 were operated upon for gangrene and 10 for stenosis.
In order to clarify the secondary extention of thrombus after intestinal resection without removing emboli, experiments were carried out and clinical data were also analized revealing the essential necessity to remove the emboli, even when the intestinal resection was carried out.
Aortoiliac vascular reconstruction has a risk to develope intestinal ischemic lesions. For the prediction of development of ischemic lesions during operation stump pressure of inferior mesenteric artery, both ultra-sound and laser doppler flowmetry were measured, revealing good correlations. Post-operatively, tonometric measurement for intramural pH(pHI), refractance spectrophotmetric measurement for oxygen saturation and endoscopic laser doppler flowmetry were carried out to the 8 risky cases. Critical level of pHI for development of ulcer was calculated as 6.86. Oxygenated perfluorochemicals were effective to prevent the ischimic leions when applied in early course of the desease. Tonometry is useful for this purpose.

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