Surgical manipulation of the small intestine and its effect on the lung.
BACKGROUND
Surgical manipulation of the intestine results in generation of oxygen free radicals leading to mucosal damage as evidenced by ultrastructural and biochemical changes. It is likely that the gut-derived mediators can bring about damage to distant organs such as the lung.


METHODS
Surgical manipulation of the gut was performed by opening the abdominal wall and handling the intestine. Lung damage was assessed by histology, markers of oxidative stress, and protein content in bronchoalveolar lavage fluid. Protection offered by pretreatment with various compounds such as allopurinol, L-arginine, quinacrine, and indomethacin was also studied.


RESULTS
Gut manipulation resulted in neutrophil infiltration, oxidative stress, and permeability changes in the lung and these changes were maximum 30 and 60 min following surgical manipulation, which recovered with time and reversed to normal by 24 h. Prior treatment with inhibitors of xanthine oxidase, phospholipase A(2), or cyclooxygenase showed a protective effect against lung damage.


CONCLUSIONS
This study has shown that laparotomy and intestinal handling result in distant organ (lung) damage which is probably brought about by neutrophil infiltration and oxidative stress on the lung. This is likely mediated by compounds generated in the intestine and transported into the systemic circulation since inhibition of generation of chemical mediators in the intestine offers protection against lung damage.
Thomas
Simmy
S
The Wellcome Trust Research Laboratory, Department of Gastrointestinal Sciences, Christian Medical College Hospital, Vellore, India.
Karnik
Swapnil
S
Balasubramanian
K A
KA
D000493:Allopurinol / Q000494:pharmacology; D000818:Animals; D001120:Arginine / Q000494:pharmacology; D002374:Catalase / Q000378:metabolism; D016861:Cyclooxygenase Inhibitors / Q000494:pharmacology; D004791:Enzyme Inhibitors / Q000494:pharmacology; D005231:Fatty Acids, Unsaturated / Q000378:metabolism; D005260:Female; D007213:Indomethacin / Q000494:pharmacology; D007421:Intestine, Small / Q000276:immunology / Q000601:surgery*; D008168:Lung / Q000201:enzymology* / Q000276:immunology / Q000473:pathology; D008297:Male; D018375:Neutrophil Activation / Q000502:physiology*; D018384:Oxidative Stress / Q000187:drug effects / Q000276:immunology; D009195:Peroxidase / Q000378:metabolism; D011796:Quinacrine / Q000494:pharmacology; D051381:Rats; D017208:Rats, Wistar; D017382:Reactive Oxygen Species / Q000378:metabolism; D013482:Superoxide Dismutase / Q000378:metabolism; D024502:alpha-Tocopherol / Q000378:metabolism
D016861:Cyclooxygenase Inhibitors; D004791:Enzyme Inhibitors; D005231:Fatty Acids, Unsaturated; D017382:Reactive Oxygen Species; D000493:Allopurinol; D001120:Arginine; D002374:Catalase; D009195:Peroxidase; D013482:Superoxide Dismutase; D011796:Quinacrine; D024502:alpha-Tocopherol; D007213:Indomethacin