Abstract
For many patients, rectal catheters are an effective means to manage bowel incontinence. Unfortunately, the incidence of catheter leakage in these patients remains troublingly high. Matching the mechanical properties of the catheter and the surrounding tissue may improve the catheter seal and reduce leakage. However, little data is available on the mechanical properties of colorectal tissue. Therefore, our group examined the mechanical properties of colorectal tissue obtained from both a common animal model and humans. Uniaxial tension tests were performed to determine the effects of location, orientation, and species (porcine and human) on bowel tissue tensile mechanical properties. Bowel tissue ultimate strength, elongation at failure, and elastic modulus were derived from these tests and statistically analyzed. Ultimate tensile strength (0.58 MPa, 0.87 MPa), elongation at failure (113.19%, 62.81%), and elastic modulus (1.83 MPa, 5.18 MPa) for porcine and human samples respectively exhibited significant differences based on species. Generally, human tissues were stronger and less compliant than their porcine counterparts. Furthermore, harvest site location and testing orientation significantly affected several mechanical properties in porcine derived tissues, but very few in human tissues. The data suggests that porcine colorectal tissue does not accurately model human colorectal tissue mechanical properties. Ultimately, the tensile properties reported herein may be used to help guide the design of next generation rectal catheters with tissue mimetic properties, as well as aid in the development of physical and computer based bowel models.
Highlights
Health care providers responsible for the treatment of critical care patients or long term nursing home residents are frequently faced with the challenge of managing fecal incontinence (Bliss et al 2007; Borrie and Davidson 1992; Peet et al 1995)
Porcine and human tissue samples exhibited significant differences from each other for all tested parameters, with elongation at failure being lower in human samples, and ultimate strength and elastic modulus being higher in human samples
We believe a mechanically realistic human bowel model could have significant clinical utility as a training tool. This focused biomechanics study provides a comprehensive set of both porcine and human bowel tissue tensile mechanical properties, encompassing testing of tissues segregated by both harvest location and testing orientation
Summary
Health care providers responsible for the treatment of critical care patients or long term nursing home residents are frequently faced with the challenge of managing fecal incontinence (Bliss et al 2007; Borrie and Davidson 1992; Peet et al 1995). Persistent fecal contamination can lead to incontinence associated dermatitis (Long et al 2011; Zimmaro Bliss et al 2006) which can lead to breakdown of the skin within the perineal of perigential areas. The management of fecal incontinence has focused on the containment of stool using absorbent pads and pouches. Similar in concept to the urinary catheter, rectal catheters can reduce the incidence of fecal contamination by directly channeling stool from the colon to a collection bag. The use of rectal catheters to mange fecal incontinence has been shown to reduce both the incidence of incontinence associated dermatitis and the overall cost of treating these patients (Kowal-Vem et al 2009; Pittman et al 2012)
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