Inhibition of Upper Gastrointestinal Secretions by Reinfusion of Succus Entericus into the Distal Small Bowel

Abstract

We prospectively studied peritonitis secondary to small bowel leakage in 30 critically ill patients, each of whom had complete diversion of intestinal continuity by stoma, fistula, or both. All patients received total parenteral nutrition during implementation of the protocol. The proximal intestinal effluent was collected and recycled into the distal small bowel. During reinfusion of succus entericus, a significant reduction in the output of the proximal stoma was observed (mean 30.2%, p less than 0.001). The reinfusion also significantly reduced the volume from isolated small bowel loops in six patients (32.6%, p less than 0.001). When isotonic dialysate solution was infused into the distal intestine, a lesser though significant reduction in stoma output occurred (mean 20.3%, p less than 0.001). These findings demonstrate a consistent inhibitory effect upon upper gastrointestinal secretions by reinfusion of succus entericus. Clinical benefits of this technique include simplified control of fluid and electrolyte balance in patients with high output stomas and optimal utilization of remaining absorptive capacity for enteral nutrition.

Chyme Reinfusion for Small Bowel Double Enterostomies and Enteroatmospheric Fistulas in Adult Patients: A Systematic Review

“…When CR was instead performed into the distal DES limb, there was a 30% decrease in output from the proximal limb. They postulated that this was due to an inhibitory effect on the upper gastrointestinal (GI) tract secretions initiated by chyme within the distal small bowel . The authors compared chyme flow before CR with the ultimate fecal losses of the downstream intestinal segment (from the anus, colostomy, or terminal ileostomy, depending on the anatomy) during CR, because of the difficulty in measuring chyme flow during CR.…”

“…Most notable was the Enteromate system (Société Labodial, Les Clayes-sous-Bois, France), introduced by Levy et al in 1983, which employs a roller pump to aspirate intestinal output into a disposable container. 32 The volume and weight of the aspirated fluid is continuously monitored and, upon reaching a preset value, an infusion pump is activated to initiate reinfusion. An updated homeuse Enteromate system was more recently utilized by Picot et al in a larger prospective study.…”

“…They postulated that this was due to an inhibitory effect on the upper gastrointestinal (GI) tract secretions initiated by chyme within the distal small bowel. 32 The authors compared chyme flow before CR with the ultimate fecal losses of the downstream intestinal segment (from the anus, colostomy, or terminal ileostomy, depending on the anatomy) during CR, because of the difficulty in measuring chyme flow during CR. A consistent reduction in the proximal DES or EAF output after initiating CR was documented in 4 studies, all reporting statistical significance (P < .001).…”

Role of damage control enterostomy in management of children with peritonitis from acute intestinal disease

“…One report has noted a dramatic decrease in mortality from 82.5% to 33.8% and later to 20% with enterostomy in postoperative peritonitis after anastomotic dehiscence. [12] Intestinal anastomosis may be unsafe in critically ill patients with peritonitis from intestinal perforation, intestinal gangrene or anastomotic dehiscence. In this scenario, damage control enterostomy is required.…”

Short-bowel syndrome - surgical treatment with long-term benefit?

“…If present proximal ostomies should be taken down as early as possible to avoid further atrophy of the distal part. In double-barreled ostomies, reinfusion of the succus entericus into the distal loop can be advantageous until the time of definite take down [30]. Increased stool losses due to the effect of more bile acids on the colon can be counteracted by colestyramine.…”