Healing of the Intestine in Experimental Bowel Infarction

Abstract

SURGEONS are familiar with ischemic bowel injury largely because of experience with strangulation obstruction. Extensive investigations have been carried out to determine criteria of viability of a compromised segment of bowel. If serious doubt remains in such cases, the problem is readily resolved by resection. In massive bowel infarction from superior mesenteric artery obstruction, resection may not be reasonable because of the amount of bowel involved, and arterial reconstruction may be the only hope for salvage. Recovery may depend, in this instance, not only upon the ability to restore circulation but the healing potential of very severely damaged bowel. Clinical experience has shown that recovery from a severe ischemic injury of the entire small bowel is possible,14 and also that healing may be associated with a prolonged period of functional disability.15 These studies were undertaken to document the nature of the ischemic damage to bowel, to relate the pathologic lesion to duration of ischemia, and to examine the potential and sequences of healing. S Submiiitted for pub)lication juinc 7, 1961.

Adequate Venous Drainage

“…9 Nonlethal ischemia of a jejunal transfer can result in disastrous functional complications and failure of the reconstructive effort despite flap survival. 10 Hikida and colleagues 11 realized an increase in complication rate when ischemia time increased beyond 3 hours. Several authors have attempted to decrease untoward effects of ischemia, ischemia reperfusion, and vascular compromise by cooling the flap, flushing the jejunal tissue with various electrolyte solutions using intraluminal irrigation, and intravascular heparinization after flap harvest.…”