Computed Tomography Perfusion Imaging Detection of Microcirculatory Dysfunction in Small Intestinal Ischemia-Reperfusion Injury in a Porcine Model

Abstract

ObjectiveTo evaluate multi-slice computed tomography (CT) perfusion imaging (CTPI) for identifying microcirculatory dysfunction in small intestinal ischemia−reperfusion (IR) injury in a porcine model.Materials and MethodsFifty-two pigs were randomly divided into 4 groups: (1) the IR group (n = 24), where intestinal ischemia was induced by separating and clamping the superior mesenteric artery (SMA) for 2 h, followed by reperfusion for 1, 2, 3, and 4 h (IR-1h, IR-2h, IR-3h, and IR-4h; n = 6, respectively); (2) the sham-operated (SO) group (n = 20), where the SMA was separated without clamping and controlled at postoperative 3, 4, 5, and 6 h (SO-3h, SO-4h, SO-5h, and SO-6h; n = 5, respectively); (3) the ischemia group (n = 4), where the SMA was separated and clamped for 2 h, without reperfusion, and (4) baseline group (n = 4), an additional group that was not manipulated. Small intestinal CTPI was performed at corresponding time points and perfusion parameters were obtained. The distal ileum was resected to measure the concentrations of malondialdehyde (MDA) and superoxide dismutase (SOD) and for histopathological examination.ResultsThe perfusion parameters of the IR groups showed significant differences compared with the corresponding SO groups and the baseline group (before ischemia). The blood flow (BF), blood volume (BV), and permeability surface (PS) among the 4 IR groups were significantly different. BF and BV were significantly negatively correlated with MDA, and significantly positively correlated with SOD in the IR groups. Histopathologically, the effects of the 2-h ischemic loops were not significantly exacerbated by reperfusion.ConclusionCTPI can be a valuable tool for detecting microcirculatory dysfunction and for dynamic monitoring of small intestinal IR injury.

Characterization and evolution of intestine injury at the anhepatic phase in portal hypertensive rats

“…The epithelial cells of the intestinal mucosa are particularly sensitive to hypoxia-ischemia upon intestinal congestion and the intestine is perhaps the most sensitive organ to I/R injury (10). A key consequence of intestinal IR injury is the breakdown of the intestinal barrier function, which results in bacterial translocation, endotoxemia, and uncontrolled release of inflammatory mediators and cytokines (11,12). Diffusion of bacteria and toxins is a primary cause of systemic inflammatory response syndrome, multiple organ dysfunction syndrome and multiple organ failure (12).…”

Simvastatin nanoparticles attenuated intestinal ischemia/reperfusion injury by downregulating BMP4/COX-2 pathway in rats

“…32 The intestines were collected after reperfusion for 1 h and the blood was purged drastically, homogenized (100 mg), and centrifuged at 3,600× g for 20 min to gain the liquid supernatant. SOD activity and MDA level were checked through xanthine oxidase and thiobarbituric acid method.…”

Ileo-ileal fistula with severe malnutrition caused by strangulated ileus surgery while preserving ischemic ileum: A case report

“…In surgical cases of strangulated ileus, intestinal blood flow and the possible need for bowel resection must be evaluated after the incarceration has been reduced [ 2 ]. However, there were no clear criteria for judging whether to preserve or remove the ischemic intestinal tract [ 1 ]. Therefore, evaluating bowel ischemia is difficult in some patients.…”

“…However, intestinal resection has risks of anastomotic leakage and stenosis. There are several reports on intestinal blood flow evaluation methods, such as intraoperative indocyanine green fluorescence imaging, CT perfusion imaging, laser Doppler velocimetry, and tissue reflectance spectrophotometry [ [1] , [2] , [3] , 14 , 15 ]. To confirm these effects, further clinical studies are required.…”

“…In cases of strangulated ileus, intestinal preservation should be attempted to the greatest extent possible; however, there are no deterministic criteria for evaluating intestinal blood flow [ [1] , [2] , [3] ]. Therefore, judgment may be difficult in some cases [ [1] , [2] , [3] ]. Entero-enteric fistula is a rare complication that occurs in patients with inflammatory bowel disease and other intestinal diseases [ 4 ].…”