Fluorescein angiography in the evaluation of intestinal intramural haemorrhage after trauma.

Intramural hemorrhage of the intestines occur after different types of abdominal trauma. These haemorrhages may lead to secondary perforation and peritonitis. As the bleeding often is multifocal, radical resections would entail correspondingly many anastomoses, with increased risk of complications. A method for macroscopic recognition of perforation risk was described in a previous report. The macroscopic criteria used in that classification have now been compared with a vital staining technique, involving intravenous injection of fluorescein. The fluorescence patterns of 'non-viability' accorded well with histologically observed damage to the muscular layer of the gut and with transmural devitalization. There was also good correlation with the macroscopic criteria in the previous classification, but the fluorescein method was higher predictive of transmural devitalization. When the methods were combined, the detection of dangerous lesions was still improved. Fluorescein staining is clinically applicable, and thus can be a valuable complement for discerning heightened risk of perforation in intestinal intramural haemorrhages.