Hindawi Publishing Corporation Case Reports in Medicine Volume 2012, Article ID 195926, 3 pages doi:10.1155/2012/195926 Case Report Venous Small Bowel Infarction: Intraoperative Laser Doppler Flowmetry Discriminates Critical Blood Supply and Spares Bowel Length S. A. Ka¨ser, P. M. Glauser, and C. A. Maurer Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Liestal, University of Basel, 4410 Liestal, Switzerland Correspondence should be addressed to C. A. Maurer, christoph.maurer@ksli.ch Received 15 July 2012; Accepted 23 September 2012 Academic Editor: Martin G. Mack Copyright © 2012 S. A. Ka¨ser et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. In mesenteric infarction due to arterial occlusion, laser Doppler ﬂowmetry and spectrometry are known reliable noninvasive methods for measuring microvascular blood ﬂow and oxygen utilisation. Case Presentation. As an innovation we used these methods in a patient with acute extensive mesenteric infarction due to venous occlusion, occurring after radical right hemicolectomy. Aiming to avoid short bowel syndrome, we spared additional 110 cm of small bowel, instead of leaving only 80 centimetres of clinically viable small bowel in situ. The pathological examination showed only 5 mm of vital mucosa to be left distal to the dissection margin. No further interventions were necessary. Conclusion. Laser doppler ﬂowmetry and spectrometry are potentially powerful methods to assist the surgeon’s decision-making in critical venous mesenteric perfusion, thus having an important impact on clinical outcome. 1. Introduction Laser Doppler ﬂowmetry (LDF) [1] and spectrometry [2] are reliable noninvasive methods for measuring viability of human tissue. LDF is a known reliable predictor of ischemic injury in acute mesenteric infarction due to arterial occlusion [3]. Mesenteric venous thrombosis is rare and most often can be treated with anticoagulants only [4]. However, if surgical treatment is required [5], the intraoperative assessment of bowel viability is hazardous, even if doppler sonography or ﬂuorescein is used [6]. As an innovation we used LDF and spectrometry to assess bowel viability in a case of acute postoperative mesenteric infarction due to mesenteric venous thrombosis. 2. Case Presentation Revision laparotomy due to septic condition one day after radical right hemicolectomy showed an extensive infarction of the small bowel in a ﬁfty-one year old woman as seen in Figure 1. She had mesenteric venous thrombosis involving the ileum and the jejunum probably due to compromised blood ﬂow in the superior mesenteric vein. The proximal part of the jejunum of about 80 cm (segment I), was slightly congested but appeared to be vital. The other part of the smaller intestine up to the ileocolic anastomosis (segments II and III) was congested and viability was highly questionable. The colon (segment IV) looked normal. Aiming to avoid short bowel syndrome, we decided to use LDF and spectrom- etry to save as much bowel as possible (O2C device, LF-2 probe, LEA Medizintechnik GmbH, Germany). In this unknown situation we used general threshold values recommended by the manufacturer (microvascular haemoglobin concentration <90 units, microvascular ﬂow >10 units, microvascular haemoglobin oxygenation >10%). At the time of measurement positive end-expiratory pressure was 5 mmHg, the patient was eucapnic and without hypoxia, her mean arterial blood pressure was 80 mmHg, the haema- tocrit was 34 percent, 30 micrograms norepinephrine per minute was administered and she had received pantoprazole, metamizole, midazolam, fentanyl, propofol, atracurium, metronidazole, cefuroxime, and imipenem. Starting our measurements at the proximal part of the jejunum and proceeding stepwise towards the terminal