A new endoscopic approach to investigate the length of involvement of acutely ischaemic bowel without surgery
EAES Academy. Baban A. 07/05/22; 362976; P019
Assoc. Prof. Ahmed Baban
Contributions
Contributions
Abstract
Aims:
The acurate assesment of remaining bowel viability following an acute bowel ischaemia can not be obtained by CT scans alone. Ultimate diagnosis involves invasive surgical techniques under general anaesthesia particularly in younger age group. We present a case were an endoscopic assessment using a paediatric colonoscope was performed in an acutely unwell patients. The aim was to avoid a potential futile explarotory surgery.
Methods:
A 52 years old patient with no major ill health presented acutely unwell as an emergency. Case note review and CT imaging was analysed. A new approach was undertaken by using a paediatric colonoscope to assess accurcey of bowel length that is still viable in small bowel ischaemia to indicate or avoid definitive surgical intervention.
Results:
Findings from CT scan was of diffuse bowel ischaemia in a young patient and no prevoius major comoribidity. Paediatric colonoscope that have similar width and nearly double the lengtho of a standard gastroscope was used and confirmed ischaemic changes starting at 20 cm (Figure 1) and severe ischaemia at 30 cm (Figure 2) from duodeno-jejunal junction. Therefore exploratory surgical intervention was avoided and palliative support was started.
Conclusion:
Successful visualisation of small bowel lumen using the paediatric colonoscopic can accurately assess the viability of bowel without a a diagnostic surgery under general anaesthesia. This permits a less distressful procedure to determin definitive management in younger patients who are fit but an unnecessary surgery can be avoided were the outcome would remain remain poor. It makes management options of intervention or palliation easier.
The acurate assesment of remaining bowel viability following an acute bowel ischaemia can not be obtained by CT scans alone. Ultimate diagnosis involves invasive surgical techniques under general anaesthesia particularly in younger age group. We present a case were an endoscopic assessment using a paediatric colonoscope was performed in an acutely unwell patients. The aim was to avoid a potential futile explarotory surgery.
Methods:
A 52 years old patient with no major ill health presented acutely unwell as an emergency. Case note review and CT imaging was analysed. A new approach was undertaken by using a paediatric colonoscope to assess accurcey of bowel length that is still viable in small bowel ischaemia to indicate or avoid definitive surgical intervention.
Results:
Findings from CT scan was of diffuse bowel ischaemia in a young patient and no prevoius major comoribidity. Paediatric colonoscope that have similar width and nearly double the lengtho of a standard gastroscope was used and confirmed ischaemic changes starting at 20 cm (Figure 1) and severe ischaemia at 30 cm (Figure 2) from duodeno-jejunal junction. Therefore exploratory surgical intervention was avoided and palliative support was started.
Conclusion:
Successful visualisation of small bowel lumen using the paediatric colonoscopic can accurately assess the viability of bowel without a a diagnostic surgery under general anaesthesia. This permits a less distressful procedure to determin definitive management in younger patients who are fit but an unnecessary surgery can be avoided were the outcome would remain remain poor. It makes management options of intervention or palliation easier.
Aims:
The acurate assesment of remaining bowel viability following an acute bowel ischaemia can not be obtained by CT scans alone. Ultimate diagnosis involves invasive surgical techniques under general anaesthesia particularly in younger age group. We present a case were an endoscopic assessment using a paediatric colonoscope was performed in an acutely unwell patients. The aim was to avoid a potential futile explarotory surgery.
Methods:
A 52 years old patient with no major ill health presented acutely unwell as an emergency. Case note review and CT imaging was analysed. A new approach was undertaken by using a paediatric colonoscope to assess accurcey of bowel length that is still viable in small bowel ischaemia to indicate or avoid definitive surgical intervention.
Results:
Findings from CT scan was of diffuse bowel ischaemia in a young patient and no prevoius major comoribidity. Paediatric colonoscope that have similar width and nearly double the lengtho of a standard gastroscope was used and confirmed ischaemic changes starting at 20 cm (Figure 1) and severe ischaemia at 30 cm (Figure 2) from duodeno-jejunal junction. Therefore exploratory surgical intervention was avoided and palliative support was started.
Conclusion:
Successful visualisation of small bowel lumen using the paediatric colonoscopic can accurately assess the viability of bowel without a a diagnostic surgery under general anaesthesia. This permits a less distressful procedure to determin definitive management in younger patients who are fit but an unnecessary surgery can be avoided were the outcome would remain remain poor. It makes management options of intervention or palliation easier.
The acurate assesment of remaining bowel viability following an acute bowel ischaemia can not be obtained by CT scans alone. Ultimate diagnosis involves invasive surgical techniques under general anaesthesia particularly in younger age group. We present a case were an endoscopic assessment using a paediatric colonoscope was performed in an acutely unwell patients. The aim was to avoid a potential futile explarotory surgery.
Methods:
A 52 years old patient with no major ill health presented acutely unwell as an emergency. Case note review and CT imaging was analysed. A new approach was undertaken by using a paediatric colonoscope to assess accurcey of bowel length that is still viable in small bowel ischaemia to indicate or avoid definitive surgical intervention.
Results:
Findings from CT scan was of diffuse bowel ischaemia in a young patient and no prevoius major comoribidity. Paediatric colonoscope that have similar width and nearly double the lengtho of a standard gastroscope was used and confirmed ischaemic changes starting at 20 cm (Figure 1) and severe ischaemia at 30 cm (Figure 2) from duodeno-jejunal junction. Therefore exploratory surgical intervention was avoided and palliative support was started.
Conclusion:
Successful visualisation of small bowel lumen using the paediatric colonoscopic can accurately assess the viability of bowel without a a diagnostic surgery under general anaesthesia. This permits a less distressful procedure to determin definitive management in younger patients who are fit but an unnecessary surgery can be avoided were the outcome would remain remain poor. It makes management options of intervention or palliation easier.
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