Intestinal Strangulation Research Articles

Intestinal Incarceration and Strangulation by the Median Ligament of the Urinary Bladder in a Dog

A 4.5-year-old female spayed, mixed-breed (Beagle X Cavalier King Charles Spaniel) presented with acute onset of vomiting and abdominal pain. The dog had undergone an exploratory celiotomy for comparable symptoms 9 months earlier, with no aetiology identified. Computed tomography (CT) was highly suggestive of mechanical obstruction of the small intestine. An exploratory celiotomy was performed and identified strangulation of the jejunum by a rent within the median ligament of the urinary bladder. It was hypothesised the rent formed secondary to previous surgical trauma. Complete excision of the median ligament resulted in resolution of clinical signs. This report emphasises the importance of minimising the formation of mesenteric rents when performing abdominal surgery.

SCROTAL HERNIATION AND STRANGULATION OF THE SMALL INTESTINE IN AN INTACT MALE 3-YEAR-OLD MIXED-BREED DOG

Importance: This case report describes a rare presentation of scrotal herniation and strangulation of the small intestine in a 3-year-old intact male mixed-breed dog. This condition is noteworthy due to its potential for severe complications and the scarcity of documented cases in the veterinary literature, contributing to the limited body of knowledge on scrotal hernias in dogs, especially those involving intestinal strangulation. Case Presentation: The dog presented with unilateral scrotal swelling, persistent vomiting and inappetence for 10 days. Physical examination revealed inflamed and tender scrotal regions, with the left side more prominently affected. Radiographic findings indicated dilated small intestines and increased radiopacity in the scrotal area. Surgical intervention revealed a swollen left testicle and a hemorrhagic loop of small intestines within the scrotum. A midline celiotomy was performed to resect and anastomose the devitalized intestinal segment, followed by herniorrhaphy. Conclusions and Relevance: The patient recovered uneventfully and resumed normal activities within a week post-surgery. This case highlights the clinical importance of timely diagnosis and surgical management of scrotal hernias in dogs to prevent life-threatening complications, underscoring the need for awareness of such presentations among veterinarians. The successful outcome in this case supports the efficacy of surgical intervention in similar scenarios, potentially guiding future clinical practices.

Flowmetry and spectrophotometry can detect reduced intestinal microperfusion in nonsurvivors during equine colic surgery for large intestinal strangulation.

To evaluate the use of laser Doppler flowmetry and spectrophotometry (LDFS) for large intestinal viability assessment in horses with naturally occurring large intestinal strangulations. By use of LDFS, intestinal microperfusion was quantified as tissue oxygen saturation (tSo2), hemoglobin (tHB), and blood flow (tBF) in cases with large colon volvulus and small colon strangulations undergoing colic surgery (n = 17). Intestinal biopsies were taken from the pelvic flexure in all large colon cases and in small colon cases that underwent intraoperative euthanasia. Measurements were compared between survivors and nonsurvivors, and the correlation between LDFS and (immuno)histology was tested (P < .05). The tSo2 and tBF were clearly lower and tHB was higher than previously reported in healthy horses. Following correction of the lesion, pelvic flexure tBF was significantly lower than that of the left ventral colon. Prior to correction of the lesion, microperfusion did not differ between survivors and nonsurvivors, but following release of the strangulation the survivors had a significantly higher tSo2 and tBF compared to the nonsurvivors. There was a negative correlation between tBF and interstitium-to-crypt ratio and a positive correlation between tHB and the histological hemorrhage score. There were no significant correlations between LDFS measurements and inflammatory cell counts or hypoxia-inducible factor-1α immunoreactivity. Large intestinal microperfusion was decreased in nonsurvivors compared to survivors and was correlated with histological injury, suggesting that LDFS has the potential to predict tissue injury and postoperative survival. The use of LDFS as an ancillary diagnostic aid may improve intraoperative viability assessment during colic surgery.

Successful intestinal blood flow evaluation using indocyanine green fluorescent imaging in a case of small intestine strangulation: a case report

Abstract Introduction The assessment of intestinal blood flow using indocyanine green (ICG) fluorescence imaging is useful in ischemic bowel disease because it renders blood flow visible. Strangulated small intestine is a common postoperative complication requiring massive bowel resection, which can cause short bowel obstruction (SBO), a malabsorptive condition. Here, we report a successful case of preserving an ischemic intestinal segment while avoiding SBO based on the gap between the macroscopic findings and the ICG fluorescence imaging assessment. Case presentation A 46-year-old Japanese female patient who underwent an abdominal total hysterectomy and bilateral salpingo-oophorectomy with para-aortic lymphadenectomy due to small round cells of the left ovary was diagnosed with strangulated small intestine 1 month postoperatively. Macroscopic examination during the laparotomy revealed a strangulated small intestine with severe edema and dark red discoloration. However, this part of the bowel was preserved during surgery because the two-time administration of ICG solution revealed adequate perfusion. Conclusion This report reveals the effectiveness of ICG fluorescence imaging in intra-operative intestinal perfusion and its role in avoiding unnecessary massive resections. Combining these modalities may be effective for intra-operative bowel assessment; however, more accurate criteria and algorithms for evaluating blood flow and bowel perfusion should be established.

Retroperitoneal hernia following laparoscopic living-donor nephrectomy: a case report and review of literature

BackgroundThe laparoscopic approach is the standard of care for living-donor nephrectomy. A rare postoperative complication is small bowel obstruction due to a retroperitoneal hernia. We present a case of an incidental finding of a retroperitoneal hernia in a patient with a history of laparoscopic donor nephrectomy.Case presentationAn adult male presented with diffuse abdominal pain, vomiting, and obstipation for 12 h. He had undergone laparoscopic donor nephrectomy two months prior. Plain abdominal radiograph revealed a dilated small bowel with homogenous opacity in the left lumbar region. Due to worsening diffuse abdominal pain and a high clinical suspicion of intestinal strangulation and ischemia after conservative management, an exploratory laparotomy was performed. Intraoperatively, an incarcerated small bowel segment herniating through an 8 cm descending mesocolon defect into the retroperitoneal space was discovered, forming a closed-loop obstruction. The bowel segment was reduced, and the mesocolon defect was repaired. The patient was discharged five days postoperatively with good recovery.ConclusionRetroperitoneal hernia following laparoscopic living-donor nephrectomy is a rare but significant complication. Mitigation to prevent mesenteric defect creation, routine inspection, and closure of the defect can reduce the risk of hernia. Non-specific abdominal pain in patients with a history of laparoscopic donor nephrectomy prompts rapid imaging evaluation to aid in the early diagnosis of possible retroperitoneal hernia and its intervention.

A novel nomogram integrating body composition and inflammatory-nutritional markers for predicting postoperative complications in patients with adhesive small bowel obstruction.

Postoperative complications in adhesive small bowel obstruction (ASBO) significantly escalate healthcare costs and prolong hospital stays. This study endeavors to construct a nomogram that synergizes computed tomography (CT) body composition data with inflammatory-nutritional markers to forecast postoperative complications in ASBO. The study's internal cohort consisted of 190 ASBO patients recruited from October 2017 to November 2021, subsequently partitioned into training (n = 133) and internal validation (n = 57) groups at a 7:3 ratio. An additional external cohort comprised 52 patients. Body composition assessments were conducted at the third lumbar vertebral level utilizing CT images. Baseline characteristics alongside systemic inflammatory responses were meticulously documented. Through univariable and multivariable regression analyses, risk factors pertinent to postoperative complications were identified, culminating in the creation of a predictive nomogram. The nomogram's precision was appraised using the concordance index (C-index) and the area under the receiver operating characteristic (ROC) curve. Postoperative complications were observed in 65 (48.87%), 26 (45.61%), and 22 (42.31%) patients across the three cohorts, respectively. Multivariate analysis revealed that nutrition risk score (NRS), intestinal strangulation, skeletal muscle index (SMI), subcutaneous fat index (SFI), neutrophil-lymphocyte ratio (NLR), and lymphocyte-monocyte ratio (LMR) were independently predictive of postoperative complications. These preoperative indicators were integral to the nomogram's formulation. The model, amalgamating body composition and inflammatory-nutritional indices, demonstrated superior performance: the internal training set exhibited a 0.878 AUC (95% CI, 0.802-0.954), 0.755 accuracy, and 0.625 sensitivity; the internal validation set displayed a 0.831 AUC (95% CI, 0.675-0.986), 0.818 accuracy, and 0.812 sensitivity. In the external cohort, the model yielded an AUC of 0.886 (95% CI, 0.799-0.974), 0.808 accuracy, and 0.909 sensitivity. Calibration curves affirmed a strong concordance between predicted outcomes and actual events. Decision curve analysis substantiated that the model could confer benefits on patients with ASBO. A rigorously developed and validated nomogram that incorporates body composition and inflammatory-nutritional indices proves to be a valuable tool for anticipating postoperative complications in ASBO patients, thus facilitating enhanced clinical decision-making.

Small intestinal strangulation in 60 cattle – clinical, laboratory and ultrasonographic findings, treatment and outcome

BackgroundIntestinal strangulation is constriction of the intestine by a band of tissue, ligament or blood vessel causing partial or complete intestinal obstruction. This retrospective study describes the clinical, laboratory and ultrasonographic findings, treatment and outcome of 60 cows with intestinal strangulation.ResultsThe general condition was abnormal in all cows (60/60), 23.3% (14/60) had nonspecific signs of pain, 40.0% (24/60) had signs of colic and 48.3% (29/60) had signs of somatic (parietal) pain. The most common digestive tract abnormalities were, in decreasing frequency, reduced or absent intestinal motility (100%, 60/60), reduced or absent faecal output (98.3%, 59/60), reduced or absent rumen motility (93.4%, 56/60), dilated small intestines on transrectal palpation (63.3%, 38/60), positive ballottement and swinging auscultation (BSA) and/or percussion and simultaneous auscultation (PSA) on the right side of the abdomen (58.3%, 35/60) and at least one positive foreign body test, most commonly the back grip, in 33.9% (20/59) of the cows. Other common findings were reduced skin surface temperature (67.8%, 40/59), reduced skin turgor (51.7%, 31/60), prolonged capillary refill time (49.2%, 29/59), enophthalmus (48.3%, 29/60) and moderate to severe scleral injection (46.6%, 27/58). The most common laboratory findings were hypokalaemia (58.3%, 35/60), haemoconcentration (57.6%, 34/59), base excess (51.1%, 24/47), hyperproteinaemia (45.8%, 27/59), hyperbilirubinaemia (43.3%, 26/60), acidosis (42.6%, 20/47) and azotaemia (38.3%, 23/60). The principal ultrasonographic findings were subjectively reduced or absent small intestinal motility and dilated small intestines, but the strangulation could not be visualised by ultrasonography. With one exception, all cows underwent a right flank laparotomy to resolve the strangulation by transection or resection of the impinging tissue. Forty-nine (81.7%) cows were discharged and 11 (18.3%) were euthanized before, during or after surgery.ConclusionsWithout laparotomy, intestinal strangulation could be clinically (transrectally) diagnosed in only 10% of the cows. A laparotomy is therefore essential for the correct diagnosis. The prognosis is good with prompt surgical treatment.

Surgical Repair of Diaphragmatic Hernia-Related Small Intestinal Strangulation in a Neonatal Foal

Surgical Repair of Diaphragmatic Hernia-Related Small Intestinal Strangulation in a Neonatal Foal

Use of multiple admission variables better predicts intestinal strangulation in horses with colic than peritoneal or the ratio of peritoneal:blood l-lactate concentration.

Early identification of strangulating obstruction (SO) in horses with colic improves outcomes, yet early diagnosis of horses requiring surgery for SO often remains challenging. To compare blood and peritoneal fluid l-lactate concentrations, peritoneal:blood l-lactate ratio, peritoneal minus blood (peritoneal-blood) l-lactate concentration and other clinical variables for predicting SO and SO in horses with small intestinal lesions (SO-SI) and then to develop a multivariable model to predict SO and SO-SI. Retrospective cohort. A total of 197 equids admitted to a referral institution for colic between 2016 and 2019 that had peritoneal fluid analysis performed at admission were included. Twenty-three admission variables were evaluated individually for the prediction of a SO or SO-SI and then using multivariable logistic regression. Odds ratios (ORs) with 95% confidence intervals (CI) and area under the curve of the receiver operator characteristic (AUC ROC) were calculated. All variables performed better in the model than individually. The final multivariable model for predicting SO included marked abdominal pain (OR 5.31, CI 1.40-20.18), rectal temperature (OR 0.30, CI 0.14-0.64), serosanguineous peritoneal fluid (OR 35.34, CI 10.10-122.94), peritoneal-blood l-lactate (OR 1.77, CI 1.25-2.51), and peritoneal:blood l-lactate ratio (OR 0.36, CI 0.18-0.72). The AUC ROC was 0.91. The final multivariable model for predicting SO-SI included reflux volume (OR 0.69, CI 0.56-0.86), blood l-lactate concentration (OR 0.43, CI 0.22-0.87), serosanguineous peritoneal fluid (OR 4.99, CI 1.26-19.74), and peritoneal l-lactate concentration (OR 3.77, CI 1.82-7.81). Retrospective, single-hospital study design. Blood and peritoneal fluid l-lactate concentrations should be interpreted in conjunction with other clinical variables. The relationship between peritoneal and blood l-lactate concentration for predicting SO or SO-SI was complex when included in a multivariable model. Models to predict SO probably vary based on lesion location.

Sigmoid mesocolon internal hernia: a case report.

We report here the case of a 67-year-old male who presented with acute intestinal obstruction and underwent an abdominal CT scan. The patient was diagnosed with an internal hernia from the imaging of the abdominal CT scan and scheduled for an exploratory laparotomy. An internal hernia was found in the mesocolon of the sigmoid colon; one loop of jejunum was trapped in the hernia defect. After reduction, the hernial defect was closed; no resections were done, and the patient was discharged after 5 days without complication. Our finding represents a transmesosigmoid hernia, a rare variant of sigmoid mesocolon hernias. The clinical sign and the judgment of the surgeon for the diagnosis of an internal hernia became important factors related to the patient's outcome. The proper adjunct imaging, correct diagnosis, and timing of surgery for internal hernias save the patient from morbidity or intestinal death.

A computed tomography-based radiomic model for the prediction of strangulation risk in patients with acute intestinal obstruction

BackgroundWe created and validated a computed tomography (CT)-based radiomic model using both clinical factors and the radiomic signature for assessing the strangulation risk of acute intestinal obstruction. This would assist surgeons in accurately predicting intestinal ischemia and strangulation in patients with intestinal obstruction. MethodsWe recruited 289 patients with acute intestinal obstruction admitted in the Affiliated Hospital of Qingdao University from January 2019 to February 2022. The patients were allocated to a training (n = 226) and validation cohort (n = 63). Radiomic features were collected from CT images, and the radiomic signature was extracted and used to calculate a radiomic score (Rad-score). A nomogram was constructed using the clinical features and the Rad-score, and the performance of the clinical, radiomics, and nomogram models was assessed in the two cohorts. ResultsSix robust features were used to construct the radiomic signature. The nomogram incorporating hemoglobin levels, C-reactive protein levels, American Society of Anesthesiologists score, time of obstruction, CT image of mesenteric fluid (P < 0.05), and the signature demonstrated good predictive ability for intestinal ischemia in patients with acute intestinal obstruction, with areas under the curve of 0.892 (95% confidence interval, 0.837–0.947) and 0.781 (95% confidence interval, 0.619–0.944) for the training and validation sets, respectively. The decision curve analysis showed that this model outperformed the clinical and radiomic signature models. ConclusionThe radiomic nomogram may effectively predict intestinal ischemia in patients with acute intestinal disease and may assist clinical decision-making.

A Prospective Study of Clinicoradiological Scores in Predicting risk of Strangulation in Bowel Obstruction

Introduction: Acute intestinal obstruction is one of the common surgical emergencies leading to variable amount of morbidity and mortality. Strangulation is the most important factor in influencing the outcome and it is critical to accurately and promptly identify the existence of intestinal strangulation. The objective of the study was to assess the clinicoradiological scores in predicting risk of strangulation in bowel obstruction.&#x0D; Methods: A prospective study of 50 patients with clinical diagnosis of acute intestinal obstruction attending General Surgery department of Government Mohan Kumaramangalam Medical College and Hospital, Salem during January 2021 and September 2022.&#x0D; Results: Most of the study population is between 51 – 60 years with mean age of 55 years with male predominance. Mean time between admission and surgery is 6 hours. All patients had previous history of surgery, with appendicectomy being most common followed by hollow viscous perforation. Of the 50 patients in the study 19 patients underwent resection. Pain &gt; 4 days, Guarding, Total leucocyte count &gt; 10000/mm3, CRP &gt; 75mg/dl, reduced contrast enhancement in CECT is frequently found in strangulated obstruction. On comparing with Schwenter score, of 36 patients who scored 0 -3, 5 patients underwent resection whereas all 14 patients who scored &gt; 4 underwent resection.&#x0D; Conclusions: A combination of clinical, laboratory and radiological parameters helps in earlier prediction of risk of ischaemia in acute intestinal obstruction and timely intervention.

Congenital trans-mesenteric hernia as a cause of small intestine strangulation in a dog

Congenital trans-mesenteric hernia as a cause of small intestine strangulation in a dog

Changes in equine intestinal stem/progenitor cell number at resection margins in cases of small intestinal strangulation.

Intestinal epithelial stem cells (ISC) are responsible for epithelial regeneration and are critical to the intestine's ability to regain barrier function following injury. Evaluating ISC biomarker expression in cases of small intestinal strangulation (SIS) may provide insight into clinical progression. Intestinal resection margins from cases of SIS were evaluated to determine if (1) evidence of injury could be identified using histomorphometry, (2) ISC biomarker expression was decreased in the proximal resection margin compared to control and distal resection margin, and (3) the ISC biomarker expression was associated with the number of preoperative risk factors negatively related to outcome, post-operative complications, or case outcome. Retrospective cohort study. Intestinal samples were obtained intraoperatively from resection margins of adult horses with SIS and horses euthanised for reasons unrelated to colic. Preoperative risk factors negatively related to outcome, post-operative complications, and case outcome were obtained from medical records. Horses were grouped as euthanised intraoperatively, postoperatively, or survived to discharge. Histomorphometry and immunofluorescence were performed to evaluate tissue architecture and ISC and progenitor cell number. Groups were compared using one-way ANOVA. Associations between biomarker expression and the number of preoperative risk factors and post-operative complications negatively related to outcome were determined using linear regression modelling. Thirty-six cases of SIS were evaluated. Ki67+ cell counts were decreased in the proximal (mean=15.45 cells; 95% CI= 10.27-20.63; SD=4.17; p= 0.02) and distal resection margins (mean=15.05; 95% CI=8.46-21.64; SD=4.141; p= 0.03) in horses euthanised postoperatively compared to control (mean=23.62 cells; 95% CI=19.42-27.83; SD=5.883). In the distal resection margin, an increase in SOX9+ Ki67+ cells were associated with a decrease in the total number of preoperative risk factors negatively related to outcome (95% CI = 0.236-1.123; p= 0.008, SE=0.1393). Small population size. Proliferating cell and ISC numbers may be associated with case outcome.

Entrapment of a jejunocecostomy anastomosis in the epiploic foramen in a horse

A mare aged 9 years underwent surgical correction of a small intestinal volvulus using a side-to-side, hand-sewn jejunocecal anastomosis. Nine months after the jejunocecostomy, the horse developed colic signs and ultrasonographic examination revealed gas in the large colon in the upper right flank region and several enlarged loops of the small intestine in the lower right flank area. The differential diagnosis was right dorsal displacement of the large colon or small intestinal strangulation. The exploratory celiotomy found epiploic foramen entrapment (EFE) of the jejunocecostomy anastomosis, including parts of the distal jejunum and cecum. Manual reduction of herniation of the bowel in the epiploic foramen (EF) was impossible and the horse was euthanized. The postmortem gross finding revealed the enlarged edematous at the distal end of the jejunum and the initial body portion of the cecum had passed into the EF in the right-to-left (antegrade) direction. To the authors’knowledge, this is the first report of the antegrade epiploic foramen entrapment of a jejunocecostomy bowel part and this may be one of the complications encountered during the long-term survival period of a surgical jejunocecostomy in horses.

Novel and simple method using cable ties to induce intestinal strangulation in a rat model

BACKGROUND The pathogenesis of intestinal fibrosis after strangulation in abdominal surgery is not fully understood. Developing an experimental and reliable method is needed to overcome this problem. This study aimed to develop an effective method for intestinal strangulation leading to fibrosis, which might induce intestinal obstruction.&#x0D; METHODS This study was conducted from 2018 to 2019 at the Department of Pharmacology, Faculty of Medicine, Universitas Indonesia. A total of 24 Sprague Dawley rats were used in this study. Artificial intestinal strangulation using cable ties made of durable plastic, which is generally used to ligate objects, was applied, and rats were further classified into control, 6-hour, and 24-hour strangulation groups. At the end of the study, the rats were sacrificed, intestinal tissues were collected, and histomorphological changes were observed using hematoxylin and eosin stain. Moreover, Masson’s trichome staining was used to assess collagen density.&#x0D; RESULTS Median collagen density score of the 24-hour strangulation group was higher than the control. A significant difference in collagen density was found between the submucosal layer of the 24-hour strangulation group and the control (45.4 [11.4] versus 32.4 [14.0], p&lt;0.001) and between the mucosa of the 6- and 24-hour strangulation groups and the control (26.9 [17] versus 6.46 [4.3], p = 0.01 and 24.9 [8] versus 6.46 [4.3], p = 0.004, respectively).&#x0D; CONCLUSIONS The simple use of cable ties adequately promotes intestinal strangulation.

Incarcerated right inguinal hernia containing sigmoid colon: An unusual case report.

IntroductionIncarcerated inguinal hernia is an irreducible but the blood supply to the contained part is intact, but developing towards strangulation. Diagnosis usually made by physical examination. The content of hernia sac may vary. The usual finding is a segment of small intestine and less commonly large intestine. Except in sliding hernia, the sigmoid colon is not common in inguinal hernia, especially on the right side.Case reportWe report a rare case of an incarcerated right side inguinal hernia containing the sigmoid colon of a 65-year old male, diagnosed with physical examination and abdominal ultrasonography. This patient treated by reducing the content of hernia sac and herniorraphy in general surgery ward of Aliabad Teaching Hospital.DiscussionInguinal hernia is the commonest of all groin hernia. Incarcerated inguinal hernia can lead to intestinal obstruction, strangulation and infarction. The content of inguinal hernia varies widely. In our case, the content of hernia sac was the incarcerated loop of sigmoid colon. The sigmoid colon is commonly found to herniate at the left inguinal region, but as a content of a right side inguinal hernia is rare.ConclusionThe sigmoid colon as a content of a right side inguinal hernia is rare. Mesh repair has always been a subject of debate due to increased risk of mesh infection rates. Many patients present complications due to delayed elective repair of inguinal hernia.

Use of barbed suture for thoracoscopic repair of diaphragmatic hernias: Three cases

SummaryThree horses were diagnosed with a dorsally located diaphragmatic hernia/tear associated with either a penetrating injury in the first case or with signs of small intestine strangulation in the remaining two cases. After diagnosis during exploratory thoracoscopy (Case 1) or emergency laparotomy (Cases 2 and 3), closure of the dorsal defect in the diaphragm was performed through a thoracoscopic approach in all cases. Defects were closed with barbed suture with either a direct suturing technique or an automated suturing device. All horses recovered uneventfully and were alive at follow‐up (2 to 3 years after surgery). No significant complications or recurrence were reported.

Time limit to rescue intestine with viability at risk caused by blood flow disruption in patients presenting with acute abdomen

PurposeEarly management is crucial for acute intestinal blood flow disorders; however, no published study has identified criteria for the time limit for blood flow resumption. This study specifically examines the time factors for avoiding intestinal resection.MethodsThe subjects of this retrospective cohort study were 125 consecutive patients who underwent emergency surgery for a confirmed diagnosis of intestinal strangulation (n = 86), incarceration (n = 27), or volvulus (n = 12), between January 2015 and March 2021. Intestinal resection was performed when intestinal irreversible changes had occurred even after ischemia was relieved surgically. We analyzed the relationship between the time from computed tomography (CT) imaging to the start of surgery (C-S time) and intestinal resection using the Kaplan–Meier method and calculated the estimated intestinal rescue rate. Patient background factors affecting intestinal resection were also examined.ResultsThe time limit for achieving 80% intestinal rescue rate was 200 min in C-S time, and when this exceeded 300 min, the intestinal rescue rate dropped to less than 50%. Multivariate analysis identified the APACHE II score as a significant influencing factor.ConclusionA rapid transition from early diagnosis to early surgery is critical for patients with acute abdomen originating from intestinal blood flow disorders. The times from presentation at the hospital to surgery should be reduced further, especially for severe cases.

Effects of intestinal strangulation release on liver following intestinal ischemia-reperfusion injury on Sprague Dawley rat

Effects of intestinal strangulation release on liver following intestinal ischemia-reperfusion injury on Sprague Dawley rat