title: Application of distractive forces to the small intestine: defining safe limits.
abstract: BACKGROUND
  Distraction enterogenesis is a novel method for increasing small bowel length by the application of linearly directed forces. However, the magnitude of distractive forces that human and animal small bowel can safely withstand is unknown.
  
  
  METHODS
  Acute ex vivo force-displacement curves for human (n = 5) and pig (n = 6) small intestine (with and without mesentery) were made by applying increasing amounts of distractive forces to bowel immersed in normal saline (39°C). Progressive load was applied until gross disruption of the tissue was detected, or the applied force reached 1000 gram-force (gf). Histology was used to detect evidence of load-induced damage. In vivo blood flow to pig bowel with distractive loads (30-200 gf) was measured by laser Doppler.
  
  
  RESULTS
  The relationship between the level of force and degree of displacement was linear. The presence of a mesentery increased stiffness of pig bowel, but did not affect human bowel. Gross tissue disruption in pig and human tissue was seen at forces between 235 and 295 gf, respectively. However, in grossly undamaged areas, histology was unchanged even after application of higher loads. With in vivo testing, mesenteric blood flow was present up to 200 gf; however, blood flow to the bowel wall was reduced to undetectable levels at loads exceeding 100 gf.
  
  
  CONCLUSIONS
  While whole bowel tissue may tolerate greater applied loads, blood flow to the bowel wall was compromised at loads over 100 gf, suggesting that any higher forces place the bowel at risk for ischemia. These measurements will help guide the clinical application of distraction enterogenesis.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan 48109-0245, USA.
authors.forename: Eiichi A
authors.initials: EA
authors.lastname: Miyasaka
authors.forename: Manabu
authors.initials: M
authors.lastname: Okawada
authors.forename: Brent
authors.initials: B
authors.lastname: Utter
authors.forename: Haytham
authors.initials: H
authors.lastname: Mustafa-Maria
authors.forename: Jonathan
authors.initials: J
authors.lastname: Luntz
authors.forename: Diann
authors.initials: D
authors.lastname: Brei
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D019245:Compressive Strength; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology*; D008875:Middle Aged; D012778:Short Bowel Syndrome / Q000503:physiopathology / Q000628:therapy*; D013152:Splanchnic Circulation; D013314:Stress, Mechanical; D013552:Swine