Case Reports in Medicine 3 Figure 3: The histologic examination shows a haemorrhagic ischemic necrosis of the mucosa of the smaller intestine with a transmural congestion (corresponding to segment III in the other ﬁgures). Only 5 mm of vital mucosa was left next to the cut margin. ileum, we deﬁned the cut margin just before the recom- mended threshold values were reached as seen in Figure 2. The viable colon was used for reference measurement. Instead of 80 cm we could preserve 190 cm of small bowel. A split stoma was constructed to avoid primary anastomosis. After operation lactate ion levels decreased to normal values, the stoma remained vital and no further surgical intervention was required. No long-term parenteral nutri- tion was needed. The histological examination showed the haemorrhagic ischemic necrosis reaching to the cut margin as near as 5 mm (Figure 3). 3. Discussion As threshold values for this clinical situation are missing, we had to use general threshold values to deﬁne the cut margin. Using the viable colon for reference measurement, we could exclude systemic factors having major impact on our measurements. The measured microvascular haemoglobin value was possibly measured too high due to petechiae and suﬀusions, but it conﬁrmed our diagnosis of mesenteric venous con- gestion. The cut margin was ﬁnally deﬁned by the values of LDF as the threshold value of microvascular blood ﬂow was reached ﬁrst. Using only clinical assessment of bowel viability, we would have left 80 cm of bowel in situ. Thus, we could spare additional 110 cm of small bowel by using LDF and spectrometry. Probably, we were able to avoid short bowel syndrome with all its sequelae. We conclude that LDF and spectrometry are potentially powerful methods to assist the surgeon’s decision-making in critical venous mesenteric perfusion, thus having an import- ant impact on clinical outcome. However, since the methods are delicate, the measurements have to be done meticulously and the results need to be interpreted carefully. References [1] A. Humeau, W. Steenbergen, H. Nilsson, and T. Stro¨mberg, “Laser Doppler perfusion monitoring and imaging: novel approaches,” Medical and Biological Engineering and Comput- ing, vol. 45, no. 5, pp. 421–435, 2007. [2] F. W. Leung, “Endoscopic reﬂectance spectrophotometry and visible light spectroscopy in clinical gastrointestinal studies,” Digestive Diseases and Sciences, vol. 53, no. 6, pp. 1669–1677, 2008. [3] C. A. Redaelli, M. K. Schilling, and M. W. B u¨chler, “Intraop- erative laser Doppler ﬂowmetry: a predictor of ischemic injury in acute mesenteric infarction,” Digestive Surgery, vol. 15, no. 1, pp. 55–59, 1998. [4] W. A. Oldenburg, L. L. Lau, T. J. Rodenberg, H. J. Edmonds, and C. D. Burger, “Acute mesenteric ischemia: a clinical review,” Archives of Internal Medicine, vol. 164, no. 10, pp. 1054–1062, 2004. [5] R. Y. Rhee and P. Gloviczki, “Mesenteric venous thrombosis,” Surgical Clinics of North America, vol. 77, no. 2, pp. 327–338, 1997. [6] J. L. Ballard, W. M. Stone, J. W. Hallett, P. C. Pairolero, and K. J. Cherry, “A critical analysis of adjuvant techniques used to assess bowel viability in acute mesenteric ischemia,” American Sur- geon, vol. 59, no. 5, pp. 309–311, 1993.