Edorium Journal of

Surgery

 
     
Original Article
 
Endoscopic assisted second-look in the management of mesenteric vascular occlusion
Mohamed Lotfy1, Ramadan M. Ali1, Ahmed R. Abd-Elfattah1
1MD, Department of Surgery, Faculty of Medicine, Zagazig University, Egypt

Article ID: 100022S05ML2017
doi:10.5348/S05-2017-22-OA-6

Address correspondence to:
Mohamed Lotfy
Department of Surgery, Faculty of Medicine
Zagazig University
Egypt

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How to cite this article
Lotfy M, Ali RM, Abd-Elfattah AR. Endoscopic assisted second-look in the management of mesenteric vascular occlusion. Edorium J Surg 2017;4:28–33.


ABSTRACT

Aims: To evaluate the role of the endoscopic assisted second-look in patients with mesenteric vascular occlusion (MVO).
Methods: Between February 2016 and February 2017, 25 patients were operated for the treatment of MVO. For all patients resection of variable lengths of bowels was performed. In spite of the clinical course of the patients, the endoscopic assisted second-look examination was performed 72 hours postoperatively at the bed side in the ICU or in the operating room via a large nelaton rectal tube catheter which was put in the patients’ abdominal cavity to assist the drainage and to give an access to the peritoneal cavity postoperatively.
Results: The mean time of admission after the onset of symptoms was three days (range, 1–5 days). In all patients, laparotomy was performed and variable lengths of dead small bowel mean 2.25 meters (range 1–3 meters) were resected and anastomosis was done. In 18 patients, the endoscopic assisted second-look examination revealed normal bowel viability and apparently good anastomosis, In five patients, intestinal necrosis was detected and in two patients anastomotic leakage was detected. For those seven patients, a second operation was necessary for further resection of the necrotic part of bowel and to correct the anastomotic leakage respectively.
Conclusion: The endoscopic assisted second-look is a minimally invasive, simple approach that can be performed at the bed-side for diagnosing the progress of MVO. It also helps to decrease the need for unnecessary second laparotomy, however, Close clinical and laboratory observation of all patients, even those with negative second-look procedures cannot be omitted.

Keywords: Endoscopy, Mesenteric vascular occlusion, Second-look


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Author Contributions
Mohamed Lotfy – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Ramadan M. Ali – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Ahmed R. Abd-Elfattah – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Mohamed Lotfy et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.





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