Abstract
In cases of “short bowel syndrome” caused by massive intestinal resection, the production of a segment of new, functional mucosa may be of great clinical significance, contributing to the patients' long-term rehabilitation. In an effort to investigate the various aspects of jejunal neomucosa, jejunal defects were patched with colonic serosa in 50 dogs. In one group animals were patched without any previous operation, while another group included animals patched after previous massive resection of the small bowel. A group which underwent resection without patching, as well as a group of normal animals served as controls. Neomucosa formed in almost all the animals as early as 4 weeks after surgery. The newly formed mucosa demonstrated features of normal jejunal mucosa as evidenced by histological, morphometrical, and enzyme histochemical examinations. Enlargement of villi and hyperplasia of villar enterocytes were found mostly marked in the animals with previous resection of the small bowel. Goblet cell hyperplasia was present in all the cases. Formation of muscularis mucosae in the neomucosa was evident. Most of the histochemically demonstrable enzymatic activities were normal or even enhanced in the mature villar epithelial cells of the neomucosa. Proliferating, metabolically immature cells showed low enzymatic activity. While at 4 weeks after operation the increase in the width of the villi was obvious, 50 weeks later the villi were strikingly enlarged in length, especially after previous resection. In the surrounding mucosa in both groups, but more so in the resected animals, a considerable structural and functional stimulation of the jejunal mucosa surrounding the patch occurred. The intestinal remnant after resection without patching showed signs of adaptation, but these were less striking than in the patched animals. The clinical results in the animals with resection and patching showed a marked improvement in comparison with nonpatched animals.
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