Crohn's disease and anastomotic recurrence: microvascular ischaemia and anastomotic healing in an animal model.
Microvascular injury and ischaemia may be factors in anastomotic recurrence after resection for Crohn's disease. This hypothesis was explored in a ferret model of multifocal intestinal infarction. At laparotomy, isolated loops of small intestine were injected intraarterially with styrene microspheres (test loop) or saline (control). At a second laparotomy 72 h later, test and control loops were divided and an end-to-end anastomosis performed between test loops (n = 2), test and control loops (n = 9) or control loops (n = 2). Abnormalities including chronic transmural inflammation, ulceration and granuloma formation were identified 2 weeks after the second operation in ten of the 11 surviving animals; changes were confined to the test loops and were more prominent adjacent to the anastomosis. No abnormalities were seen in control loops. The combination of two self-limiting ischaemic insults can produce a pattern of intestinal inflammation similar to that seen in anastomotic recurrence in Crohn's disease.
Osborne
M J
MJ
University Department of Surgery, Royal Free Hospital and School of Medicine, London, UK.
Hudson
M
M
Piasecki
C
C
Dhillon
A P
AP
Lewis
A A
AA
Pounder
R E
RE
Wakefield
A J
AJ
D000714:Anastomosis, Surgical; D000818:Animals; D003424:Crohn Disease / Q000503:physiopathology / Q000601:surgery*; D004195:Disease Models, Animal; D005289:Ferrets; D007421:Intestine, Small / Q000098:blood supply / Q000601:surgery*; D007511:Ischemia / Q000209:etiology; D012008:Recurrence; D014945:Wound Healing