Abstract
BackgroundA mechanical intestinal obstruction (MIO) can generate intraabdominal hypertension (IAH) that is life threatening. The intestines are very sensitive to IAH since the low splanchnic perfusion causes intestinal hypoxia, local acidosis and bacterial translocations. This may lead to acute intestinal distress syndrome (AIDS). The identification of intestinal injuries during IAH and its correlation with clinical parameters as the abdominal perfusion pressure (APP), the gastric intramucosal pH (pHi) and lactic acid (Lc) are still unknown. This study aimed to evaluate the sequence of intestinal histopathological findings in an MIO model and to analyze potential relationships with parameters currently used in clinical practice (APP, pHi and Lc).Material and methodsTwenty pigs were divided into three groups: a control group (n = 5) and two experimental groups with 20 mmHg (G1, n = 10) and 30 mmHg (G2, n = 5) of IAH by MIO. The pressures were maintained for 3 hours, except in 5 animals in G1 where it was maintained for 5 hours. The APP, pHi and LA were recorded and biopsies of the terminal ileum were taken every 30 minutes in all groups. The intestinal damage was graded according to the Park Score.ResultsIntestinal injuries were found in 42.9% of pigs in the experimental groups. The lesions were independent of the level and duration of IAH. Although APP and pHi were slightly lower in injured animals (I +) of G1 and G2, there were no significant differences among those uninjured (I-). Lc was significantly increased in all I+ pigs from the onset of IAH.ConclusionThe IAH by MIO causes intestinal lesions from the first 30 minutes with concurrent decreases in APP and pHi and increases in Lc. Lc could be the best clinical parameter related to intestinal damages with a clear difference between I + and I- animals.
Highlights
lactic acid (Lc) could be the best clinical parameter related to intestinal damages with a clear difference between I + and I- animals
Mechanical intestinal obstruction (MIO) is a predisposing cause of intra-abdominal hypertension (IAH) [1,2,3], which may lead to abdominal compartment syndrome (ACS) and multiple organ dysfunction syndrome (MODS) [4, 5]
Subsequent epithelial damage and local acidosis may lead to bacterial translocation [2, 10,11,12] and result in acute intestinal distress syndrome (AIDS) due to the inflammatory mediators and cytokines that are generated in the gut promoting local and remote tissue damage [8, 13, 14]
Summary
Mechanical intestinal obstruction (MIO) is a predisposing cause of intra-abdominal hypertension (IAH) [1,2,3], which may lead to abdominal compartment syndrome (ACS) and multiple organ dysfunction syndrome (MODS) [4, 5]. Perfusion of all abdominal organs is negatively affected by the IAH generated during MIO result of the bowel distension. This includes the perfusion-sensitive intestinal villous brush border [6,7,8], and so its vascular anatomical features predisposing to hypoxia [9]. The intestines are very sensitive to IAH since the low splanchnic perfusion causes intestinal hypoxia, local acidosis and bacterial translocations This may lead to acute intestinal distress syndrome (AIDS). The identification of intestinal injuries during IAH and its correlation with clinical parameters as the abdominal perfusion pressure (APP), the gastric intramucosal pH (pHi) and lactic acid (Lc) are still unknown. This study aimed to evaluate the sequence of intestinal histopathological findings in an MIO model and to analyze potential relationships with parameters currently used in clinical practice (APP, pHi and Lc)
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