Our Summary

Acute mesenteric ischemia (AMI) is a serious, time-sensitive condition where there is insufficient blood flow to the intestines. During treatment, doctors may need to explore the abdomen to determine which areas of the intestines can recover. These decisions are often based on clinical parameters, which can be uncertain. This research paper discusses how technology can assist in making these decisions. Tools such as laser Doppler flowmetry, indocyanine green (ICG) fluorescence angiography, and hyperspectral imaging can help in deciding which parts of the intestine to remove. The paper also discusses guidelines on the use of laparoscopy (a procedure where a small incision is made to examine the organs) and the value of planned second-look laparotomy (another surgery to check on the patient). It also gives an overview of how to prevent short bowel syndrome, a condition resulting from removing a large part of the small intestine. Other technical aspects such as when and how to create a preternatural anus and anastomosis (connecting two parts of the intestine) are also discussed.

FAQs

  1. What is Acute Mesenteric Ischemia (AMI) and how is it treated?
  2. What types of technology can assist doctors in deciding which parts of the intestines to remove during treatment for AMI?
  3. What measures can be taken to prevent short bowel syndrome after a large part of the small intestine has been removed?

Doctor’s Tip

A helpful tip a doctor might tell a patient about bowel resection is to follow post-operative care instructions carefully, including maintaining a healthy diet, staying hydrated, and avoiding strenuous activities. It is important to attend follow-up appointments and communicate any concerns or changes in symptoms to your healthcare provider. Additionally, it is crucial to address any signs of infection, such as fever, increased pain, or redness around the incision site, immediately. Following these guidelines can help ensure a successful recovery and minimize complications after a bowel resection procedure.

Suitable For

Patients who are typically recommended bowel resection include those with:

  • Acute mesenteric ischemia (AMI)
  • Bowel obstructions
  • Inflammatory bowel disease (such as Crohn’s disease)
  • Bowel perforation
  • Diverticulitis
  • Colon or rectal cancer

These conditions may require surgical removal of a portion of the bowel to treat the underlying issue and improve the patient’s quality of life. Patients who have not responded to conservative treatments or who have complications such as bowel necrosis or severe bleeding may be candidates for bowel resection.

Timeline

  • Before bowel resection:
  1. Patient presents with symptoms of AMI, such as severe abdominal pain, nausea, vomiting, and bloody stools.
  2. Patient undergoes diagnostic tests such as CT scans, angiography, and blood tests to confirm the diagnosis.
  3. Patient is stabilized and prepared for surgery, which may involve bowel resection to remove damaged or necrotic sections of the intestine.
  4. Surgeons use technology such as laser Doppler flowmetry, ICG fluorescence angiography, and hyperspectral imaging to assess blood flow and viability of the intestines.
  5. Decision is made on which parts of the intestine to remove during the surgery.
  • After bowel resection:
  1. Patient undergoes bowel resection surgery to remove damaged sections of the intestine.
  2. Patient may have a temporary ostomy (surgically created opening on the abdomen) or anastomosis to divert or reconnect the intestines.
  3. Patient is monitored closely for complications such as infection, leakage, or bowel obstruction.
  4. Patient may require a second-look laparotomy to assess the healing and function of the intestines.
  5. Patient undergoes rehabilitation and recovery to adjust to any changes in bowel function and prevent short bowel syndrome.
  6. Patient may need long-term follow-up care to monitor for any complications or nutritional deficiencies.

What to Ask Your Doctor

  1. What is the reason for needing a bowel resection?
  2. What are the potential risks and complications of the surgery?
  3. How long is the recovery process expected to be?
  4. Will I need a temporary or permanent colostomy or ileostomy?
  5. What can I expect in terms of bowel function after the surgery?
  6. Will I need any additional treatments or medications after the surgery?
  7. How often will I need follow-up appointments after the surgery?
  8. What signs or symptoms should I watch for that may indicate a complication?
  9. Will I need any dietary or lifestyle changes after the surgery?
  10. Are there any alternative treatments or procedures that could be considered instead of a bowel resection?

Reference

Authors: Kania A, Branchi V, Braun L, Verrel F, Kalff JC, Vilz TO. Journal: Chirurgie (Heidelb). 2024 May;95(5):367-374. doi: 10.1007/s00104-024-02041-w. Epub 2024 Feb 20. PMID: 38378936