Noninvasive detection of ischemic bowel

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Abstract

Purpose: Acute mesenteric arterial occlusion is an abdominal catastrophe that carries high morbidity and mortality rates. Current diagnostic methods, however, lack sensitivity and specificity and do not provide information about the viability of the affected bowel. Early diagnosis and intervention would improve patient outcomes and survival rates. The basic electrical rhythm (BER) is the omnipresent electrical slow wave of the gastrointestinal tract that characterizes the underlying electrical activity of the bowel. BER frequency is known to fall with ischemia. Superconducting quantum interference devices (SQUIDs) can detect BER by measuring the magnetic fields generated by the electrical activity of the smooth muscle of the small bowel. The purpose of this study was to determine the ability of a SQUID to detect mesenteric ischemia in a free-lying section of small bowel in an animal model of acute superior mesenteric artery occlusion. Methods: Seven adult male rabbits (six experimental and one control) were studied with transabdominal SQUID and electrode recordings during baseline and after the induction of mesenteric ischemia with balloon occlusion of the superior mesenteric artery. Continuous recordings were taken for 120 minutes of ischemia and analyzed with autoregressive spectral analysis to determine the BER frequency during specific time points of the study. Two independent investigators blinded to the experimental preparation examined the results to determine whether there was decreased BER frequency and thus ischemia. The results are expressed as mean ± SEM, and paired t tests were used to determine statistical significance. Results: BER was detected in all seven animals and fell from 10.7 ± 0.5 cpm to 7.0 ± 1.8 cpm after 30 minutes of ischemia in the magnetic channels (P < .05, with t test). The fall in BER was detected by the SQUID in all six experimental animals. The blinded observers correctly identified healthy and ischemic magnetic data recording, with a sensitivity of 94% and specificity of 100%. Conclusion: SQUIDs can noninvasively detect bowel ischemia early in a free-lying segment of small bowel in this animal model with a high degree of sensitivity and specificity.

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Seidel, S. A., Bradshaw, L. A., Ladipo, J. K., Wikswo, J., & Richards, W. O. (1999). Noninvasive detection of ischemic bowel. Journal of Vascular Surgery, 30(2), 309–319. https://doi.org/10.1016/S0741-5214(99)70142-4

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