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Case reports
Laser Doppler flowmetry is useful in the clinical management of small bowel transplantation
  1. E J Corbetta,
  2. B N Barrya,
  3. S G Pollardb,
  4. J P A Lodgeb,
  5. M C Bellamy on behalf of the Liver Transplant Groupa
  1. aDepartment of Anaesthesia and Intensive Care, St James's University Hospital, Leeds, UK, bDepartment of Transplant Surgery, St James's University Hospital, Leeds, UK
  1. Dr M C Bellamy, Leeds Teaching Hospitals, St James's University Hospital, Leeds LS9 7TF, UK. Email:mark{at}livertransplant.org.uk

Abstract

OBJECTIVE Laser Doppler flowmetry (LDF) has been used as a research tool to measure splanchnic perfusion. In this report, we aim to demonstrate the clinical value of this technique in perioperative monitoring of transplanted small bowel.

METHODS A 24 year old man underwent small bowel transplantation using a previously described technique. Microvascular blood flow in the transplanted bowel was measured using an LDF splanchnic probe. Postoperatively this was applied to the stoma facilitating direct measurements of graft mucosal flow. Measurements (perfusion units (PU)) were documented prior to implantation, post-reperfusion, postoperatively, during graft ischaemia, and in response to therapeutic interventions (dopexamine and phenylephrine infusions).

RESULTS Prior to transplantation, biological zero was established. Flow at five, 15, and 60 minutes after reperfusion was 74 (1.9) PU, 87.5 (3.3) PU, and 141.5 (2.5) PU, respectively. Postoperative mucosal flow was 141.6 (2.9) PU. Subsequent LDF measurement detected absence of flow even though clinical signs suggested only moderate reduction. This was confirmed on surgical re-exploration and facilitated prompt resection of a non-viable segment. Fluid and dopexamine administration resulted in a dose dependent improvement in flow, independent of blood pressure. Addition of phenylephrine increased total mucosal flow and unmasked a cyclical component.

CONCLUSION This case demonstrates the clinical value of LDF as an “alarm” to indicate graft perfusion failure and as a monitor for therapeutic interventions. Phenylephrine and dopexamine may both be of value in improving mucosal flow in the transplanted small bowel.

  • laser Doppler
  • small bowel transplantation
  • mucosa
  • dopexamine
  • flow motion phenomenon

  • Abbreviations used in this paper

    LDF
    laser Doppler flowmetry
    PU
    perfusion units
    MMC
    migrating motor complex

    • https://doi.org/10.1136/gut.47.4.580

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    • Abbreviations used in this paper

      LDF
      laser Doppler flowmetry
      PU
      perfusion units
      MMC
      migrating motor complex
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