What is the diagnostic role of endoscopy (sigmoidoscopy, colonoscopy, enteroscopy) and laparoscopy?
- In spite of the fact that a small number of published case reports describe diagnostic findings of mesenteric ischemia via enteroscopy, this approach can be extremely dangerous because of the high risk of bowel perforation.
- Lower endoscopy, however, has been shown to be relatively safe and can aid in determining the diagnosis of a patient with suspected ischemic colitis.
- Laparoscopy, although invasive, has also been shown to be a relatively safe technique in assisting with diagnosis and assessing the degree of injury to the intestines.
- It can easily detect full-thickness mesenteric injury; however, it is limited in the fact that it will miss the earlier stages of potentially reversible ischemia because injury starts mucosally and then moves transmurally to the serosa.
- Additionally, when intraperitoneal pressure exceeds 20 mm Hg, a level often attained after insufflation during laparoscopy, splanchnic blood flow decreases.
