A novel method for multiple bowel injuries: a pilot canine experiment

Abstract

BackgroundIntestinal ligation is the cornerstone for damage control in abdominal emergency, yet it may lead to bowel ischemia. Although intestinal ligation avoids further peritoneal cavity pollution, it may lead to an increased pressure within the bowel segments and rapid bacterial translocation. In this study, we showed that severed intestine could be readily reconnected by using silicon tubes and be secured by using rubber bands in a canine model.MethodsAdult Beagle dogs, subject to multiple intestinal transections and hemorrhagic shock by exsanguination, randomly received conventional ligation vs. silicon tubes reconnecting (n = 5 per group). Intestinal transections were carried out under general anesthesia after 24-h fasting. The abdomen was opened with a midline incision. The small intestine was severed at 50, 100, and 150 cm below the Treitz ligament. Hemorrhagic shock was established by streaming blood from the left carotid artery until the mean arterial pressure reached 40 mmHg in 20 min. Fluid resuscitation and surgery began 30 min after the establishment of hemorrhagic shock. Severed intestines were ligated or connected with silicon tubes. Definitive repair was conducted in subjects surviving for at least 48 h.ResultsOperation time was comparable between the two groups (39.6 ± 8.9 vs. 36.6 ± 7.8 min in ligation and reconnecting groups, respectively; p = 0.56). The time spent in managing each resection was also comparable (4.6 ± 1.1 vs. 3.8 ± 0.84 min; p = 0.24). Blood loss (341.2 ± 28.6 vs. 333.8 ± 34.6 ml; p = 0.48), and fluid resuscitation within the first 24 h (1676 ± 200.6 vs. 1594 ± 156.5 ml; p = 0.46) were similar. One subject in the ligation group was sacrificed at 36-h due to severe vomiting that led to aspiration. Four remaining dogs in the ligation group received definitive surgery, but two out of four had to be sacrificed at 24-h after definitive repair due to imminent death. All five dogs in the reconnecting group survived for at least a week. Radiographic examination confirmed the integrity of the GI tract in the reconnecting group. In both groups, plasma endotoxin concentration increased after damage control surgery, but the increase was much more pronounced in the ligation group. Microscopic examination of the involved segment of the intestine revealed much more severe pathology in the ligation group.ConclusionThe current study showed that the reconnecting resected intestine by using silicon tubes is feasible under emergency. Such a method could decrease short-term mortality and minimize endotoxin translocation.

Effect of Copaiba Oil in Intestinal Mucosa of Rats Submitted to Hypovolemic Shock

“…Trauma is one of the leading causes of death in the world, especially in young adults 12 . Several are the mechanisms that lead to severe organ dysfunctions 16 , and hypovolemic shock is one of the most common. It causes ischemia of several organs, especially kidneys and splanchnic territory 3 , 15 .…”

Modified Finney enteroplasty: a bowel sparing damage control stapled technique for penetrating jejunal and ileal injuries

“…solid organs, colon, stomach, etc) [4]. With patients in extremis, damage control principles mandate leaving these segments of intestine in discontinuity, to allow for warming of the patient and ongoing resuscitation while achieving source control of the enteral spillage [5]. The downside of this approach is the inevitable swelling of the intestine that will occur with the resuscitation [5,6] and will make the bowel reconstruction much more challenging and perhaps less safe [6].…”

“…With patients in extremis, damage control principles mandate leaving these segments of intestine in discontinuity, to allow for warming of the patient and ongoing resuscitation while achieving source control of the enteral spillage [5]. The downside of this approach is the inevitable swelling of the intestine that will occur with the resuscitation [5,6] and will make the bowel reconstruction much more challenging and perhaps less safe [6]. In addition, extensive jejunoileal resections that include many enterotomies (as recommended currently) [2,7] may increase the risk for short bowel syndrome in the current hospital stay or in a future one (given the somber fact that many of these patients will experience additional interventions for recurrent trauma in their lifetime) [8][9][10].…”