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.