Intraoperative Diagnostics of Ischemic Damage to the Small Intestine: Current Opportunities and Unsolved Challenges

Management of patients with acute intestinal ischemia remains a serious challenge for specialists involved in urgent surgery. The paper presents current trends review on the intraoperative assessment of the intestinal microvasculature during its ischemic damage, including the initial intervention and re-examination operations. The pros and cons of X-ray angiography, spiral computed tomography (CT), magnetic resonance imaging (MRI), laser Doppler flowmetry, methods based on the use of exogenous fluors and photosensitizers are described in details. The features of second-look operations in open and laparoscopic modes, their advantages and disadvantages, possible complications, indications and contraindications to each of these methods are closely examined. Particular attention is paid to the perspectives of using optical coherence tomography in surgery. However, despite all the achievements of modern surgery in the treatment of patients with acute intestinal ischemia, the problem of surgical tactics has not been completely resolved. Novel knowledge about the development of necrosis in the intestinal wall will reduce the volume of its resection and the incidence rate of postoperative complications.