Effect of manual bowel decompression (milking) in the obstructed small bowel.
BACKGROUND
Mechanical intestinal obstruction is a frequently encountered problem in general surgery. One of the frequently used techniques for surgical decompression, so-called milking, is to caress the intestinal contents cephalad into the stomach or caudally into the colon. The aim of our study was to examine the functional, morphologic, and microbiologic effects of manual bowel decompression (milking) in the obstructed small bowel.


METHODS
Six rats in the milking (M) group (obstructed and decompressed manually), 6 in the control (C) group (obstructed only), and 5 rats in the sham (S) group (laparotomy and evisceration) underwent surgery. Muscle contractility, gastrointestinal dye transmission, histopathologic changes of ileum, and bacterial translocation were analyzed.


RESULTS
The contractile response of intestinal segments to acetylcholine was significantly less in group M compared with those of groups C and S (P < .05). The maximal contractile response to acetylcholine also was significantly lower in group M (P < .05). There was no statistically significant difference between the groups regarding the sensitivity of cholinergic receptors. Frequency of peristaltic movements, progression of Evans blue dye, histopathologic variables, and the quantitative evaluation (colony-forming units/gram of tissue) of isolated bacteria were not different among the groups. However, Escherichia coli in group M and Klebsiella spp in group S were the main isolated bacteria.


CONCLUSIONS
Although it reduces muscle contractility, a milking procedure in an intestinal obstruction model does not cause peristaltic deterioration, histopathologic or inflammatory changes, or alterations in the degree of bacterial translocation.
Törer
Nurkan
N
Department of General Surgery, Baskent University Faculty of Medicine, Ankara, Turkey. ntorer@yahoo.com.tr
Nursal
Tarik Zafer
TZ
Tufan
Hale
H
Can
Fusun
F
Bal
Nebil
N
Tarim
Akin
A
Moray
Gokhan
G
Haberal
Mehmet
M
D000818:Animals; D018988:Bacterial Translocation; D005769:Gastrointestinal Motility; D045823:Ileus / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007421:Intestine, Small / Q000382:microbiology / Q000503:physiopathology; D007813:Laparotomy; D008297:Male; D011183:Postoperative Complications; D051381:Rats; D017208:Rats, Wistar