Bowel Viability Research Articles

Using computed tomography imaging for the quantitative assessment of bowel viability in incarcerated groin hernia.

Rapid assessment of bowel viability in patients with incarcerated groin hernia (IGH) is crucial. However, there have been few studies on the quantitative indicators to assess bowel viability objectively. This study investigates the usefulness of the computed tomography (CT) value of the intestinal contents in this context. The subjects of this retrospective study were 84 patients with IGH diagnosed at our hospital between April, 2011 and March, 2023. The patients were divided into two groups according to whether they had necrotic (n = 24) or non-necrotic (n = 60) IGH. We reviewed the clinic-radiological factors associated with bowel necrosis. The CT value of the incarcerated intestinal contents was significantly higher in the necrotic group than in the non-necrotic group (24.67 vs 9.33 HU, p < 0.001). Furthermore, multivariate logistic regression analysis identified the CT value of the incarcerated intestinal contents as an independent predictor of bowel necrosis (hazard ratio 275; 95% confidence interval 21.9-3450; p < 0.001). The CT value of the incarcerated intestinal contents in IGH is a reliable and objective indicator for bowel viability preoperatively. This quantitative method of evaluation is effective and independent of clinical experience and can improve decision-making in the management of this condition.

Laparoscopic-assisted repair of inguinal undescended testis with concurrent incarcerated hernia in children: a single-center experience

PurposesWe report clinical, operative, and outcome data for laparoscopic- assisted minimal procedure for treating unilateral inguinal undescended testis (UDT) with concurrent ipsilateral incarcerated hernia in children.MethodsEarly-stage cases were defined as those presenting within 24 h of symptom onset with stable vital signs and absence of peritonitis, intestinal necrosis, or testicular necrosis. A retrospective analysis was conducted on patients undergoing laparoscopic-assisted hernia repair and trans-scrotal orchidopexy (LAHRTO) procedure.ResultsA total of 14 cases were enrolled (Left, n = 4; Right, n = 10). Incarcerated hernia contents comprised viable omentum or bowel, without necrosis or intestinal perforation. Ten cases achieved successful laparoscopic reduction, while four cases required conversion to open inguinal incision due to failed reduction. All the testes were preserved and underwent the LAHRTO procedure except for those that converted. Notably, five cases of contralateral patent processus vaginalis (PPV) were identified, allowing for synchronous closure during surgery. The average operation time was (46.8 ± 5.2) min, resulting in a success rate of 71.4% (10/14). At 16–24 months of follow-up, two testes showed partial atrophy. No wound infections, hernia recurrences, or testicular retractions were observed.ConclusionsOur initial findings suggest that the LAHRTO procedure appears safe and feasible for early-stage inguinal UDT with concurrent incarcerated hernia in children, reducing inguinal incisions and enabling concurrent contralateral PPV management. A larger number of cases with longer follow-up is needed to validate the results of the current study in an evidence-based manner.

Cecal Volvulus: A Rare but Life-Threatening Cause of Intestinal Obstruction

Cecal volvulus is a rare cause of intestinal obstruction involving torsion of the cecum, ascending colon, and terminal ileum, leading to ischemia and potential perforation. It accounts for 1–1.5% of intestinal obstructions and typically arises from abnormal cecal mobility. Two forms exist: axial volvulus and cecal bascule. Diagnosis relies on imaging, with CT being the most accurate modality. Treatment is surgical, as colonoscopic reduction is rarely successful and carries risks. Options include detorsion, caecopexy, or right colectomy, depending on bowel viability.

Avoiding unnecessary bowel resection in adult intussusception: a case report in a patient with multiple prior surgeries utilizing intraoperative enteroscopy.

Intussusception is a rare condition in adults, accounting for approximately 5% of all cases. Unlike pediatric intussusception, which is typically idiopathic, the adult cases are usually associated with an underlying pathology, most commonly malignancies. The surgical intervention is often required, but in small bowel cases, where malignancy is less frequent than in colonic intussusception, the decision regarding resection requires careful consideration. There are no prior reports on the use of intraoperative enteroscopy for small bowel intussusception evaluation. We report the case of a 78-year-old woman who presented with acute abdominal pain, nausea, and bilious vomiting. She had a history of distal gastrectomy with gastroduodenostomy (Billroth-I) and total gastrectomy with Roux-en-Y for gastric ulcer and residual stomach cancer, respectively. Abdominal computed tomography (CT) revealed small bowel intussusception without clear evidence of a lead point lesion. The emergency laparotomy confirmed intussusception 15cm distal to the Roux-en-Y anastomosis, which was manually reduced. The intraoperative enteroscopy revealed inflammatory changes but no malignancy or structural abnormalities. Given the absence of a lead point lesion and the viability of the bowel, resection was avoided. The patient had an uneventful postoperative course and was discharged without complications. Adult intussusception is frequently associated with malignancy, yet cases without a lead point lesion pose a diagnostic and therapeutic challenge. The surgical history, including prior anastomotic procedures, may contribute to the pathogenesis through disrupted intestinal pacemaker activity and retrograde contractions. While second-look surgery can aid in bowel viability assessment, it carries a high complication rate. This case highlights the potential role of intraoperative enteroscopy in evaluating small bowel viability, minimizing unnecessary resection, and improving surgical decision-making. Although further studies are needed to assess its role in optimizing surgical outcomes, intraoperative enteroscopy may be a valuable adjunct in cases of adult small bowel intussusception without an apparent lead point.

Emergency Minimally Invasive Surgery for Obturator Hernias: A Systematic Review.

Despite their rarity, obturator hernias pose significant clinical challenges due to their high complication rate and frequent emergency presentation. While minimally invasive surgery has proven effective and safe for elective groin hernia repair, its application in emergency settings, particularly for obturator hernias, lacks robust evidence, highlighting a critical knowledge gap in this area. This systematic review aims to evaluate the feasibility of a minimally invasive approach for the repair of obturator hernias in emergency settings. A systematic review was conducted searching PubMed, OVID, MEDLINE, Embase, and Cochrane reviews for ((obturator hernia) AND (laparoscop* OR minimal access OR robotic)) AND (strangulat* OR obstruct* OR incarcerat*). The time of the literature is from the establishment of each database to 1 September 2023. Critical appraisal used the Joanna Briggs Institute (JBI) appraisal checklist. A systematic review of 337 manuscripts identified 47 relevant studies, including 39 case reports, 4 case series, and 4 retrospective studies. Minimally invasive approaches, particularly totally extraperitoneal (TEP), transabdominal preperitoneal (TAPP), and the Kugel procedure, demonstrated favourable outcomes for obturator hernias, including shorter operative times, reduced hospital stays, low recurrence rates, effective management of complications, and improved diagnostics, with success dependent on timely intervention, bowel viability, and patient selection. The findings suggest that minimal access surgery can effectively avoid unnecessary laparotomy for hernial content assessment, particularly when employing the TAPP approach. While emergency repair of obturator hernias using minimal access techniques appears feasible and safe, achieving outcomes comparable to open surgery requires further high-quality evidence. PROSPERO: CRD42024503724.

Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper

BackgroundDecision-making in emergency settings is inherently complex, requiring surgeons to rapidly evaluate various clinical, diagnostic, and environmental factors. The primary objective is to assess a patient’s risk for adverse outcomes while balancing diagnoses, management strategies, and available resources. Recently, indocyanine green (ICG) fluorescence imaging has emerged as a valuable tool to enhance surgical vision, demonstrating proven benefits in elective surgeries.AimThis consensus paper provides evidence-based and expert opinion-based recommendations for the standardized use of ICG fluorescence imaging in emergency settings.MethodsUsing the PICO framework, the consensus coordinator identified key research areas, topics, and questions regarding the implementation of ICG fluorescence-guided surgery in emergencies. A systematic literature review was conducted, and evidence was evaluated using the GRADE criteria. A panel of expert surgeons reviewed and refined statements and recommendations through a Delphi consensus process, culminating in final approval.ResultsICG fluorescence imaging, including angiography and cholangiography, improves intraoperative decision-making in emergency surgeries, potentially reducing procedure duration, complications, and hospital stays. Optimal use requires careful consideration of dosage and timing due to limited tissue penetration (5–10 mm) and variable performance in patients with significant inflammation, scarring, or obesity. ICG is contraindicated in patients with known allergies to iodine or iodine-based contrast agents. Successful implementation depends on appropriate training, availability of equipment, and careful patient selection.ConclusionsAdvanced technologies and intraoperative navigation techniques, such as ICG fluorescence-guided surgery, should be prioritized in emergency surgery to improve outcomes. This technology exemplifies precision surgery by enhancing minimally invasive approaches and providing superior real-time evaluation of bowel viability and biliary structures—areas traditionally reliant on the surgeon’s visual assessment. Its adoption in emergency settings requires proper training, equipment availability, and standardized protocols. Further research is needed to evaluate cost-effectiveness and expand its applications in urgent surgical procedures.Graphical abstract

Combining clinical and radiological features improves prediction of bowel ischemia in patients with CT findings of pneumatosis intestinalis.

Pneumatosis intestinalis on CT presents a diagnostic dilemma, because it could reflect bowel ischemia or benign finding. To determine radiological and clinical features that can predict bowel ischemia in patients with pneumatosis intestinalis on CT. Patients with "pneumatosis" in abdominal CT reports performed between 1/1/2002 and 12/31/2018 were retrospectively included. Pneumatosis intestinalis was confirmed by review of images. Radiological features of pneumatosis, laboratory data, clinical signs and symptoms were collected. Pathologic pneumatosis intestinalis (PPI) was defined as presence of ischemic (viable or dead) bowel on surgery or death during admission or within 30 days of discharge due to ischemia. Univariate statistical analysis was used to identify features associated with PPI, followed by multivariate logistic regression models. A total of 313 consecutive patients with pneumatosis intestinalis (162 (52%) men, median age 67 years, IQR 55-78 years) were included. Pathologic pneumatosis intestinalis was present in 114/313 (36%) patients. Presence of arterial or venous thrombosis, porto-mesenteric gas, fat stranding, and location in the small bowel were significantly associated with PPI. A combined clinical and radiological model, which included age, WBC, creatinine, abdominal distention, rebound or guarding, shock, presence of porto-mesenteric gas and fat stranding showed an AUC of 0.85 for prediction of PPI, higher than models using clinical (AUC = 0.80, p = 0.005) or radiological factors (AUC = 0.80, p < 0.0001) alone. Improved prediction of pathological pneumatosis intestinalis can be achieved by a model incorporating both clinical and radiological features (AUC = 0.85)rather than by either clinical (AUC = 0.80) or radiological (AUC = 0.80) features alone.

EP135 Human Factors and Quantitative Data: Diverging Perspectives on ICG Use in Emergency Bowel Surgery

Abstract Background Indocyanine Green (ICG) has emerged as a valuable tool in emergency bowel ischemia surgery due to its ability to enhance visualization of bowel perfusion. This meta-analysis aims to evaluate the role of ICG, focusing specifically on human factors that influence its efficacy and outcomes versus the quantitative data obtained from the same literature. Methods A systematic search was conducted on Embase and PubMed using the keywords: ICG, emergency, surgery, bowel, ischemia, and perfusion. Out of 266 articles identified, 32 original studies were included for analysis. Results ICG analysis is shown to be effective in predicting either true ischaemia or true bowel viability in 302 out of 308 cases identified. Discrepancies between visual assessment and ICG analysis were found in 38.3% (n=118) cases. Among these, ICG prediction is not always followed, resulting in further resections being needed (n=7) due to ongoing ischaemia. Conclusion ICG shows significant promise as a tool for enhancing surgical decision-making in emergency bowel ischemia. However, its clinical effectiveness is deeply influenced by key human factors, including surgeon expertise, patient characteristics (e.g. use of intra-operative inotropes, body weight), preoperative biases, and real-time decision adjustments (e.g. timing of assessment post fluorescence injection). The lack of interdisciplinary collaboration and challenges in interpreting fluorescence angiography further impact outcomes. Addressing these gaps in receptiveness, interdisciplinary integration, and decision frameworks is essential to fully harness the potential of ICG in improving surgical results. Future studies must prioritize these areas to optimize its clinical application.

A Modified Clip-and-drop Technique Using LigaSure Device in the Management of Multifocal Necrotizing Enterocolitis

Introduction: Despite the acknowledgment in the previous decades and all the extensive studies of necrotizing enterocolitis (NEC), the controversy regarding this problem is still on-going and unsolved. It is a common gastrointestinal life-threatening emergency that occurs primarily in 90% of the preterm infants. Surgery is usually indicated in approximately 27%–52% of infants with NEC. Case 1: Full-term, birth weight of 3.2 kg. At 14 days old, he developed pneumoperitonea, at exploratory laparotomy, all the necrotic segments were sealed and divided using 5 mm LigaSure device. All the edges of the resected bowel were sealed and return in the abdominal cavity. At the second look surgery, assurance of bowel viability was established. The sealed bowel segments were completely closed. Case 2: A 33-week-old gestational age, of 2000 g. was operated upon at the age of 14 days for developing pneumoperitoneum. At exploration, there was evidence of extensive NEC involving the entire small intestine reaching to the cecum with multiple necrotic and perforated areas was found. All the segments of necrosis were resected using 5-mm LigaSure device. The small areas of perforation were patched. At second-look surgery, all the sealed bowel segments and the areas of patch perforation were viable, with good sealing without any complications. Anastomosis of the multiple resected segments was done with “Shish-Kebab” technique. Discussion: Multifocal NEC is a challenging spectrum of the disease for pediatric surgeon, as there are various surgical options in their management. LigaSure is an electrothermal sealing system that combines dissecting and reconstructing abilities in a single instrument, without the need to reload with each use. Thus, it reduces the cost as well as shorten the operative time as mentioned in the previous studies. In addition, it has the advantage over clips as they do not leave any metallics in the body, furthermore, the risk to damage the surrounding structures is less due to minimal thermal spread so limited injury, and it considers easy to use. Conclusion: LigaSure device is an effective and safe method in sealing small bowel in sick neonates with multifocal NEC if applied with single application and with minimal manipulation of the bowel and most importantly minimizing the operative time.

Case Report: A small bowel occlusion revealed by a strangulated transomental hernia

Introduction Transomental hernias are a rare type of internal hernia, accounting for less than 1% of all internal hernias. They occur when abdominal contents protrude through a defect in the omentum, leading to bowel obstruction and potential strangulation. We report the case of a young male admitted for the management of an acute bowel obstruction. Case report A 38-year-old male patient with no significant medical or surgical history presented with a proximal bowel obstruction syndrome. Upon physical examination, he exhibited mild abdominal distension, tenderness in the right iliac fossa, and tympanism. Laboratory tests indicated elevated inflammatory markers. An emergency computed tomography (CT) scan suggested the presence of a congenital band or an internal hernia. A laparoscopic procedure was performed, which identified a transomental hernia with a segment of the ileum protruding through an omental defect adjacent to the transverse colon. The herniated loop of small intestine was found to be compromised and gangrenous. Due to the severity of the condition, a midline incision was made to convert the procedure, allowing for resection of the affected segment of the small intestine while preserving 2.5 meters of viable bowel distal to the duodenojejunal junction. The remaining small intestine was exteriorized as a double-barrel ileostomy, and the transomental defect was subsequently repaired. The postoperative recovery was uneventful. Conclusion Although internal hernias account for a relatively small percentage of cases, they are frequently overlooked as a cause of bowel obstruction. Diagnosis this condition is challenging, both clinically and radiologically. Facilitating prompt surgical intervention to mitigate high mortality is essential.

A Prospective Study on Lactate Dehydrogenase Levels in Acute Intestinal Obstruction as a Marker of Bowel Gangrene.

Background Intestinal obstruction continues to be one of the most common causes of emergencies presenting to the surgical department. A thorough clinical examination along with relevant investigations continue to be best modality for timely management and prompt decision-making in such cases. Objectives The aim of this study was to identify patients of intestinal obstruction with elevated levels of serum lactate dehydrogenase (LDH) and correlate elevated LDH levels with bowel viability. Materials and methods The study comprised 46 cases of intestinal obstruction and their serum LDH values measured prior to surgical intervention/first day of admission. The intra-operative bowel viability was noted and compared with LDH values obtained, and their correlation was studied along with other variables of the patient. Results In our study, it was found that a serum LDH level of >800 IU/L signified an abnormal bowel with increased risk of bowel gangrene, as indicated by a sensitivity of 75% and a specificity of 94%. Gangrenous bowel was found to be more associated with causes such as superior mesenteric artery/vein thrombosis, volvulus, and habits such as alcoholism and tobacco consumption. Elevated LDH levels, however, do not correlate with the length of the affected gangrenous bowel, with the duration of presentation of symptoms, or as a predictor of mortality. Conclusion Serum LDH can be used as a good predictor of gangrenous bowel in cases of intestinal obstruction.

Diagnostic laparoscopy with indocyanine green fluorescence test for the evaluation of intestinal perfusion in abdominal blunt injury: a case report

BackgroundThe indocyanine green (ICG) fluorescence test has become a standard test in surgical procedures, facilitating the assessment of blood perfusion in real-time. While its utility in emergency surgeries for evaluating anastomotic blood supply is well-established, its application in trauma cases, especially those involving mesenteric hematoma, remains underexplored. Herein, we present a case to illustrate the efficacy of the ICG fluorescence test in such scenarios.Case presentationA 51-year-old man with uncontrolled hypertension suffered blunt abdominal trauma following a motor vehicle accident. We used the intra-operative ICG fluorescence test to chart the surgical plan for the patient. A combination of diagnostic laparoscopy with ICG fluorescence testing effectively excluded bowel ischemia, leading to the avoidance of intestinal resection and the need for a temporary ostomy. The patient resumed enteral nutrition.ConclusionsOur case underscores the efficacy of ICG fluorescence testing in assessing bowel viability and guiding surgical strategies in trauma patients with mesenteric hematoma. By facilitating real-time visualization of blood perfusion, ICG testing enables the adoption of conservative treatments in patients who would traditionally require more invasive surgical interventions, with minimal effect on operation time and cost.

Management of Ileosigmoid Knotting: A Literature Review

Ileosigmoid knotting (ISK) is a rare double-segment intestinal obstruction form. Urgent surgery is the unique solution in the management of ISK. In surgical treatment, detorsion alone is generally used in patients with viable bowel, while cases with gangrenous bowel require resection. ISK recurrence is uncommon. However, due to the recurrence risk of sigmoid volvulus, the role of recurrence-reducing procedures is unclear. In this review, urgent treatment of ISK as well as the techniques and patient selection criteria of recurrence-reducing management are discussed.

Time to symptom onset and manual reduction outcomes as predictors of bowel viability in incarcerated obturator hernias

The current study aimed to identify the indications for manual reduction in incarcerated obturator hernias (OH). Further, whether time to symptom onset and manual reduction outcomes can be predictors of bowel viability and the need for bowel resection in incarcerated OH were examined. This retrospective study included 26 patients with incarcerated OH who underwent surgery. All patients underwent manual reduction, and computed tomography scan after manual reduction confirmed hernia release. Multivariate analyses were performed to determine the predictors of bowel resection. The bowel resection group had a significantly longer average time to symptom onset than the nonbowel resection group (88 vs 36 h). Further, the bowel resection group was more likely to have failed manual reduction than the nonbowel resection group. A time to symptom onset of ≥ 72 h and failed manual reduction were significant predictors of bowel viability. Age, sex, hernia localization, American Society of Anesthesiologists physical status score, and laboratory findings did not differ significantly between the bowel resection and nonbowel resection groups. Time to symptom onset and manual reduction outcomes are significant predictors of bowel viability in incarcerated OH. Patients with a time to symptom onset of ≥ 72 h and failed manual reduction require surgical evaluation due to a high risk of bowel nonviability. Therefore, a cautious approach is required in the management of OH, and further research on optimized treatment protocols should be conducted.

Knowledge, attitudes and practices of using Indocyanine Green (ICG) fluorescence in emergency surgery: an international web-based survey in the ARtificial Intelligence in Emergency and trauma Surgery (ARIES)-WSES project.

Fluorescence imaging is a real-time intraoperative navigation modality to enhance surgical vision and it can guide emergency surgeons while performing difficult, high-risk surgical procedures. The aim of this study is to assess current knowledge, attitudes, and practices of emergency surgeons in the use of indocyanine green (ICG) in emergency settings. Between March 08, 2023 and April 10, 2023, a questionnaire composed of 27 multiple choice and open-ended questions was sent to 200 emergency surgeons who had previously joined the ARtificial Intelligence in Emergency and trauma Surgery (ARIES) project promoted by the WSES. The questionnaire was developed by an emergency surgeon with an interest in advanced technologiesand artificial intelligence. The response rate was 96% (192/200). Responders affirmed that ICG fluorescence can support the performance of difficult surgical procedures in the emergency setting, particularly in the presence of severe inflammation and in evaluating bowel viability. Nevertheless, there were concerns regarding accessibility and availability of fluorescence imaging in emergency settings. Eighty-seven out of 192 (45.3%) respondents have a fluorescence imaging system of vision for both elective and emergency surgical procedures; 32.3% of respondents have this system solely for elective procedures; 21.4% of respondents do not have this system, 15% do not have experience with it, and 38% do not use this imaging in emergency surgery. Less than 1% (2/192) affirmed that ICG fluorescence changed always their intraoperative decision-making. Precision surgery effectively tailors surgical interventions to individual patient characteristics using advanced technology, data analysis and artificial intelligence. ICG fluorescence can serve as a valid and safe tool to guide emergency surgery in different scenarios, such as intestinal ischemia and severe acute cholecystitis. Due to the lack of high-level evidence within this field, a consensus of expert emergency surgeons is needed to encourage stakeholders to increase the availability of fluorescence imaging systems and to support emergency surgeons in implementing ICG fluorescence in their daily practice.

Diagnostic performance of contrast enhanced computed tomography in intestinal obstruction

Introduction: Intestinal obstruction (IO) is a frequent cause of admission to the surgery and emergency departments. For the prevention of complications, such as ischemia and perforation, early recognition of IO is crucial. Computed tomography (CT) provides excellent details regarding cause, site &amp; complications of IO and also helps in treatment planning.Aim: To evaluate the efficacy and accuracy of CECT imaging in diagnosing IO and detecting complications. To correlate CECT findings with surgical or histopathological findings.Materials and Methods: A prospective study was conducted in the Department of Radiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India for a period of 2 years from September 2020 to September 2022. Fifty patients with suspected intestinal obstruction were evaluated, after obtaining informed consent. Data was analysed using SPSS 22 version software.Results: Male predominance was seen in this study, males constituted 58% and females 42%. The commonest age group affected was 41-50 years .Small bowel obstruction (SBO) was much more prevalent than large bowel obstruction (LBO). The most common site of BO was ileum. The leading cause of SBO was adhesions and in LBO was bowel malignancy.Conclusion: IO is a fairly common presentation in clinical and radiological practice. There are various causes as well as mimickers of IO, which makes it a challenging task to accurately diagnose. CECT helps in treatment planning by providing information about bowel viability. We found it is extremely useful to include CECT study as a standard protocol in evaluation of patients presenting with bowel obstruction.

Analysis of Bowel Viability Alterations in Patients with Acute Small Bowel Obstruction and Comorbidities: A Case Series

Analysis of Bowel Viability Alterations in Patients with Acute Small Bowel Obstruction and Comorbidities: A Case Series

Clinical aspects of acute mesenteric ischaemia

Acute mesenteric ischaemia (AMI) is a serious disease with mortality between 50 and 80 %. Oxidative stress plays a major role in the pathophysiology of AMI. AMI should be considered for any acute abdominal pain that requires analgesia with morphine and for which no other obvious aetiology is found. CT is the main diagnostic procedure to confirm the diagnosis of AMI. There is no specific diagnostic biomarker for AMI that can be used in routine practice. AMI is an urgent diagnostic and therapeutic situation. Treatment of AMI includes a protocol combining digestive rest, curative anticoagulant, antiplatelet, antibiotic therapy, arterial revascularisation to salvage viable bowel and resection of necrotic digestive segments. The strategy of revascularisation depends on the mechanism of arterial occlusion, the morphological appearance of the lesions and the indications for exploratory laparotomy. Endovascular and open surgical techniques can be combined and complemented. Open surgical revascularisation is indicated in case of failure or impossibility of endovascular revascularisation and in case of need for laparotomy. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality of AMI. The emergence of endovascular approaches and modern imaging techniques is developing and providing new treatment options. A multidisciplinary approach based on early diagnosis and treatment is necessary.

The use of laser radiation to assess the bowel viability in an experiment

Aims: To investigate the possibility of using laser rays scattering indicators to assess the bowel viability. Methodology: 30 white rats. A loop of the middle part of the small bowel (SB) with the mesentery was ligated in 10 rats. A loop of the middle part of the large bowel (LB) with the mesentery was ligated in 10 rats. The width of the laser rays at wavelengths λ=0.63 and λ=0.4 μm scattering zone (WLRSZ) was measured (in millimeters) on the afferent (AP), efferent (EP) and ligated (LP) parts of the bowel’s walls in the in 6 hours. Sections of bowels were taken for histological examination. The data obtained by measurements in 10 healthy animals were the control. Results: In AP revealed morphological disorders without signs of necrosis, in EP revealed minor changes, in LP revealed necrosis. We used the ratio of the WLRSZ at wavelengths λ=0.63/λ=0.4 μm. Control ratio on SB and LB didn’t differ significantly. AP ratio on SB and LB was not significantly different, but was significantly different from the control. EP ratio on SB and LB was not significantly different and did not differ significantly from the control, but differed significantly from the indicators on the AP. LP ratio indicators on SB and LB was not significantly different, but significantly different from the control, indicators on AP and EP. Conclusion: 1. The ratio of the laser rays at the wavelengths λ=0.63/λ=0.4 μm scattering zone width is statistically significantly different in the bowel parts without deviated viability, with morphological deviations without signs of necrosis, and with necrosis. 2. Ratio indicators &gt; 1.58 units indicate preserved viability, indicators in the range of 1.4-1.35 units indicate morphological deviations without necrosis, indicators &lt; 1.2 units indicate bowel necrosis. 3. The determination of this ratio should be used in patients to assess its informativeness. Aims: To investigate the possibility of using laser rays scattering indicators to assess the bowel viability. Methodology: 30 white rats. A loop of the middle part of the small bowel (SB) with the mesentery was ligated in 10 rats. A loop of the middle part of the large bowel (LB) with the mesentery was ligated in 10 rats. The width of the laser rays at wavelengths λ=0.63 and λ=0.4 μm scattering zone (WLRSZ) was measured (in millimeters) on the afferent (AP), efferent (EP) and ligated (LP) parts of the bowel’s walls in the in 6 hours. Sections of bowels were taken for histological examination. The data obtained by measurements in 10 healthy animals were the control. Results: In AP revealed morphological disorders without signs of necrosis, in EP revealed minor changes, in LP revealed necrosis. We used the ratio of the WLRSZ at wavelengths λ=0.63/λ=0.4 μm. Control ratio on SB and LB didn’t differ significantly. AP ratio on SB and LB was not significantly different, but was significantly different from the control. EP ratio on SB and LB was not significantly different and did not differ significantly from the control, but differed significantly from the indicators on the AP. LP ratio indicators on SB and LB was not significantly different, but significantly different from the control, indicators on AP and EP. Conclusion: 1. The ratio of the laser rays at the wavelengths λ=0.63/λ=0.4 μm scattering zone width is statistically significantly different in the bowel parts without deviated viability, with morphological deviations without signs of necrosis, and with necrosis. 2. Ratio indicators &gt; 1.58 units indicate preserved viability, indicators in the range of 1.4-1.35 units indicate morphological deviations without necrosis, indicators &lt; 1.2 units indicate bowel necrosis. 3. The determination of this ratio should be used in patients to assess its informativeness.

Management of Sigmoid Volvulus: A Literature Review

Abstract Sigmoid volvulus (SV) is a rare form of intestinal obstruction in which the sigmoid colon twists around its own base. Endoscopic detorsion is the primary treatment in uncomplicated patients, while urgent surgery is required in the cases with bowel perforation, peritonitis, and unsuccessful endoscopic detorsion. In surgery, the gangrenous sigmoid colon is managed by resection, whereas sigmoid detorsion alone or with an additional recurrence-reducing procedure is applied in patients with viable bowel. However, the risk of recurrence following endoscopic or operative detorsion alone is as high as 90% with a risk of mortality up to 35%. To prevent or reduce SV recurrence, some selected cases require emergent or elective recurrence-preventive management including sigmoidopexy, mesopexy, mesoplasty, extraperitonealization, sigmoidectomy, and endoscopic percutaneous sigmoidopexy. However, the indications, techniques, and results of the above-mentioned procedures are controversial. In this review, the treatment options of SV and patient selection criteria for recurrence-preventive treatments are discussed.