Late regeneration of infarcted small bowel mucosa: a case report.
Ischemic injury of the small bowel may recover after revascularization, provided that full-thickness infarction did not occur. Animal studies showed that if the mucosal crypts remain viable, rapid mucosal restitution occurs hours after injury. The treatment of transmucosal infarction that does not extend to full wall thickness, however, was not investigated thoroughly. The patient presented had a mesenteric event leading to resection of about half of his small bowel. The unresected segment had severe ischemic injury, which seemed to cause transmucosal, but not transmural, infarction. Imaging of the remaining small bowel revealed a seromuscular layer denuded of mucosa. The ischemic damage was too deep to allow rapid regeneration, and the patient had short-bowel syndrome. A year later, during operation for stricture complications, new mucosa covered parts of the small-bowel surface, encouraging the surgeon to elect a conservative approach. Sixteen months after the injury, normal mucosa covered the entire small bowel, and enteral feeding resumed successfully. This report shows that infarcted small-bowel mucosa may regenerate even months after injury.
Zmora
Oded
O
Department of Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel. ozmora@post.tau.ac.il
Khaikin
Marat
M
Rosin
Danny
D
Shabtai
Moshe
M
Bar-Zakai
Barak
B
Ayalon
Amram
A
D000222:Adaptation, Physiological; D000714:Anastomosis, Surgical; D004750:Enteral Nutrition; D006801:Humans; D007413:Intestinal Mucosa / Q000502:physiology*; D007421:Intestine, Small / Q000098:blood supply* / Q000502:physiology / Q000601:surgery*; D007511:Ischemia / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012038:Regeneration; D012778:Short Bowel Syndrome / Q000601:surgery; D016896:Treatment Outcome