[Reperfusion shock after occlusion of the superior mesenteric artery and accumulation of leukocytes within the wall of the small intestine].
The epithelial damage and the accumulation of the leucocytes within intestinal wall layers after ischemia and reperfusion was investigated in a pig model. Superior mesenteric artery (SMA) was occluded for 1 h (group 2, n = 9), 2 h (group 3, n = 6) and 3 h (group 4, n = 7) with a consecutive 2 h reperfusion period. The histological evaluation was performed on hematoxylin-eosine and Naphtol AS-D chloracetate stained preparations. The intensity of reperfusion shock depended on the duration of the intestinal ischemia. After 1 h SMA occlusion systolic blood pressure stabilized at a lower level with a normalization of the serum lactate level and the intestinal intramural pHi within the reperfusion period. After 2 h SMA occlusion the decrease of the systolic blood pressure was intensified (54-69 mm Hg) with a persistent elevated serum lactate concentration and a delayed increase of the ischemic pHi values. Reperfusion after 3 h SMA occlusion caused an irreversible shock. The epithelial damage also depended on the duration of the SMA occlusion. There were no significant changes of the leucocytic accumulation within the submucosa. But a significant increase of the number of the leucocytes was seen within the inner and the outer layer of the muscularis after 1 h SMA occlusion (106+/-5/mm2 resp. 280/mm2; p<0.05). This increase was less pronounced after 2 h (92+/-5/mm2*resp. 189+/-4/mm2; *p<0.05) and 3 h of SMA occlusion (84+/-5/mm2 resp. 185+/-23/mm2). Intestinal ischemia and reperfusion caused no changes of the leucocytic accumulation within the submucosa but a significantly increased accumulation within the muscularis after 1 h SMA occlusion, which was not seen after a more elongated occlusion period. A reperfusion shock without normalization of the serum lactate level and the intramural pHi suggesting intestinal perfusion disturbances may also lead to a depression of the leucocytic accumulation within the muscularis.
Jonas
J
J
Klinik für Allgemein- und Abdominalchirurgie, Johannes-Gutenberg-Universität, Mainz.
Heimann
A
A
Alebrahim-Dehkordy
A
A
Kempski
O
O
D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D007421:Intestine, Small / Q000098:blood supply* / Q000473:pathology; D007511:Ischemia / Q000473:pathology*; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D007958:Leukocyte Count; D007962:Leukocytes / Q000473:pathology*; D017538:Mesenteric Artery, Superior / Q000473:pathology*; D008641:Mesenteric Vascular Occlusion / Q000473:pathology*; D009130:Muscle, Smooth / Q000098:blood supply / Q000473:pathology; D015427:Reperfusion Injury / Q000473:pathology*; D013552:Swine
D007773:Lactates; D019344:Lactic Acid
Reperfusionsschock nach Okklusion der A. mesenterica superior und Akkumulation von Leukozyten innerhalb der Dünndarmwand.