title: Clinicopathological evaluation of anoxic mucosal injury in strangulation ileus.
abstract: BACKGROUND
  In patients with strangulation ileus, the severity of bowel ischemia is unpredictable before surgery. To consider a grading scale of anoxic damage, we evaluated the pathological findings and investigated predictive factors for bowel gangrene.
  
  
  METHODS
  We assessed 49 patients with strangulation ileus who underwent a laparotomy between January 2004 and November 2012. Laboratory tests and the contrast computed tomography (CT) were evaluated before surgery. According to the degree of mucosal degeneration, we classified anoxic damages into the following 3 grades. Ggrade 1 shows mild mucosal degeneration with extended subepithelial space. Grade 2 shows moderate degeneration and mucosal deciduation with residual mucosa on the muscularis mucosae. Grade 3 shows severe degeneration and mucosal digestion with disintegration of lamina propria.
  
  
  RESULTS
  Resected bowel specimens were obtained from the 36 patients with severe ischemia, while the remaining 13 patients avoided bowel resection. The mucosal injury showed grade 1 in 11 cases, grade 2 in 10 cases, and grade 3 in 15 cases. The patients were divided into two groups. One group included grade 1 and non-resected patients (n = 24) while the other included grades 2 and 3 (n = 25). When comparing the clinical findings for these groups, elevated creatine kinase (P = 0.017), a low base excess (P = 0.021), and decreased bowel enhancement on the contrast CT (P = 0.001) were associated with severe mucosal injury.
  
  
  CONCLUSIONS
  In strangulation ileus, anoxic mucosal injury progresses gradually after rapid spreading of bowel congestion. Before surgical intervention, creatine kinase, base excess, and bowel enhancement on the contrast CT could indicate the severity of anoxic damage. These biomarkers could be the predictor for bowel resection before surgery.
authors.affiliation: Department of Surgery, Kurume University School of Medicine, Kurume, Japan. takahashi_ryuuji@med.kurume-u.ac.jp.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Takahashi
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Akagi
authors.forename: Takaho
authors.initials: T
authors.lastname: Tanaka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kaibara
authors.forename: Sugako
authors.initials: S
authors.lastname: Kajiwara
authors.forename: Ichirou
authors.initials: I
authors.lastname: Shima
authors.forename: Jun
authors.initials: J
authors.lastname: Taguchi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Mizobe
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Kakuma
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shirouzu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003108:Colonic Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D045823:Ileus / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D007413:Intestinal Mucosa / Q000098:blood supply* / Q000473:pathology; D007415:Intestinal Obstruction / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D007511:Ischemia / Q000209:etiology / Q000473:pathology*; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed