Splinting of the small intestine with the Miller-Abbot tube. A critical analysis of 160 cases

Using the long intestine tube (MAS) we expected to prevent early postoperative ileus. 160 cases were retrospectively examinated in order to answer whether the tube is an effective prevention for early postoperative ileus, and which danger the patient is submitted to using the tube. We found out that the incidence of early postoperative ileus using the tube is about 1.9% and the tube is doing harm by producing necroses of the bowel wall in 1.8%.     

Extended venous ischemia of the small intestine caused by portal thrombosis. Value of diagnostic celioscopy and intestinal bi-exclusion (Thiry-Vella technique)

Mesenteric venous thrombosis is a rare disease with no specific signs. It's major risk is intestinal ischaemia and necrosis. We report the case of a young women who presented with unexplained abdominal pain and subnormal abdominal ultrasound. The diagnosis was made on laparoscopic exploration which allowed anticoagulant therapy followed by proximal and distal divertingostomies of the ischemic bowel. Small bowel continuity was re-established after 3 month of total parenteral nutrition. The patients is doing well 1 year after surgery. She is still under anticoagulant therapy. The etiology found was a hypermegacaryocytosis as seen in myeloproliferative disease.     

Perforations of the small intestine and intestinal parasitic diseases. Apropos of a case of peritonitis caused by the perforation of the small intestine combined with Taenia saginata infection

A case is reported of peritonitis from perforation of the small intestine found on operation to be due to Taenia saginata. A review of the relevant literature of the last 20 years failed to find many similar cases, parasites, particularly Taenia being an exceptional direct cause of perforation. In the case reported, however, a direct cause/effect relation is highly probable.     

Role of small intestine submucosa (SIS) as a nerve conduit: preliminary report.

The goal of peripheral nerve repair is to successfully direct the regenerating fibers into the environment of the distal terminus with minimal loss of fibers at the suture line. Successful nerve repair is dependent on sensory, motor, and autonomic axons making appropriate connection with their distal terminus. The subsequent results are dependent on parameters such as the location and extent of the injury, appropriateness of realignment of the injured nerve, and the surgical technique. Peripheral nerve repair using autograft material has several shortcomings, including donor site morbidity, inadequate return of function, and aberrant regeneration. Recent peripheral nerve research has focused on the generation of synthetic conduits for nerve guidance. Small intestine submucosa (SIS) is a biological material that might better address those outcomes and improve regeneration. Its unique properties appear to offer several advantages. The SIS graft acts as a natural conduit between the proximal and distal nerves, provides a favorable growth environment, and appears to lack antigenicity. This preliminary study to evaluate the integrity of sciatic nerve repair was conducted over a period of 90 d. Distally directed growth of the proximal nerve was demonstrated histologically. Further investigations to demonstrate the extent and integrity of this regeneration are underway.     

Incarcerated internal hernia of the small intestine through a breach of the broad ligament: two cases and a literature review.

Two cases of internal herniation through a defect in the broad ligament of the uterus are described. Both were successfully treated laparoscopically. This rare condition should be borne in mind when a middle-aged woman presents with colicky lower abdominal pain. The cause is unknown, but both congenital and acquired origins have been proposed. As far as emergency situations are concerned, laparoscopy has proven to be both a diagnostic and a therapeutic tool.     

Small bowel obstruction following extended right hemicolectomy and subtotal colectomy: assessing the benefit of prophylactic tube splinting.

BACKGROUND/AIMS: Small bowel obstruction (SBO) is a frequent complication of extended right hemicolectomy and subtotal colectomy. This study was conducted to assess the prophylactic effectiveness of intestinal tube splinting. METHODS: Sixteen patients (study group) undergoing extended right hemicolectomy or subtotal colectomy were treated with and 18 patients (controls) without splinting. Clinical, operative and outcome data were entered into a maintained database. The main endpoint was subsequent SBO. RESULTS: After a follow-up of 2-13 (median 6.5) years, the study group remained free from SBO. After 1-16 years (median 2), four complete and one partial early and one complete and one complete recurrent late SBO occurred in controls. CONCLUSION: Intestinal tube splinting was comparatively easy and expeditious from a technical point of view after extended hemicolectomy and subtotal colectomy. The procedure eliminated early and up to date also late postoperative SBO in this study and can be considered as a prophylaxis against SBO in this subset of patients.     

Surgical stress and the small intestine: role of oxygen free radicals.

BACKGROUND: Any surgical procedure can be associated with altered intestinal function. The mechanism involved in these changes at the cellular level during surgical stress has not been worked out. This study looked at the biochemical and functional alterations, along with ultrastructural changes, in the intestine during surgical stress in a simple rat model. METHODS: Surgical stress was induced by opening the abdominal wall and handling the intestine as during laparotomy. The effect of oxidative stress on the enterocyte and altered intestinal permeability as well as the ultrastructural changes to the mucosa were studied. RESULTS: Surgical stress results in oxidative stress on enterocytes, as evidenced by increased xanthine oxidase and decreased catalase activity along with altered thiol redox status. This was associated with increased intestinal permeability and widened intercellular spaces. These changes were prominent at 60 minutes after laparotomy and returned to normal by 24 hours. CONCLUSIONS: Mild intestinal handling is capable of inducing oxidative stress in enterocytes; this could be one of the mechanisms by which intestinal mucosal alterations occur during surgical stress.     

Intraoperative intubation of the small intestine in surgery of mechanical intestinal obstruction. Experience with a method of intraoperative and postoperative maintenance in mechanical obstruction using a long multi-pierced tube applied intraoperatively

The Authors describe their experience from 1986 to 1990 of intraoperative intubation of the small intestine to obtain intra- and post-operative decompression of intestinal loops and for prevention or postoperative adhesions in intestinal obstruction case. Two methods are reported; one using the ready-made long intestinal "Baker" tube, and another consisting of using a self-made tube with available materials. Enumeration of cases is reported, and the lack of complications from the use of the method is stressed. The good result in the prognosis of obstructive intestinal disease is also stressed.     

Detection of intestinal ischemia,I. Microardiological and temperature differences between mesenteric and antimesenteric margin of the small intestine of the rat

Microradiographs were made of the vasculature of the ileum of rats following an injection of micropaque. The radius of vessels entering the mesenteric margin of the rat small intestine decreases significantly during its course toward the antimesenteric margin. The relative lack of vascular supply in the antimesenteric region of bowel was associated with a significant reduction (P < 0.001) of mean surface temperature as compared to its mesenteric surface. Occlusion of the blood supply to the bowel wall abolished this temperature gradient (P < 0.1). Measurement of temperature differences between the mesenteric and antimesenteric margin of the bowel wall of man may prove to be a sensitive indicator of bowel viability in intestinal surgery.     

Motor and absorptive function of the canine intestine following serosal patching: the effects of a lateral enterotomy on small intestinal myoelectrical activity

We studied the effects of serosal patching of a 4 x 15-cm, full-thickness, jejunal defect on absorptive function and fasting and postprandial myoelectrical activity in 5 patched and 5 control animals over a 3-month period. While fat and D-xylose absorption were similar in both groups, serum albumin was significantly depressed (2.96 +/- 0.24 g/dL preop vs 2.29 +/- 0.23 g/dL postop, p less than .05) and stool moisture content was elevated following patching (54 +/- 4% vs 67 +/- 9%, p less than .05). Neither the generation of the various phases of the interdigestive myoelectrical complex (IDMEC), the development of postprandial myoelectrical activity, or colonic myoelectrical patterns were impaired in the patched animals. The normal gradients of slow wave frequency, phase III propagation velocity, and onset of the fed pattern were similar in control and patched animals. However, jejunal slow wave frequency (cpm, control vs patch: 18.6 +/- 0.6 vs 19.5 +/- 0.6, p less than .05) and IDMEC frequency (0.36 +/- 0.25 vs 0.56 +/- 0.32, p less than .05) were greater and the IDMEC period shorter (109.6 +/- 27.8 vs 88 +/- 35.7, p less than .05) in the patch animals. In vitro studies demonstrated similar absorptive function in intact mucosa and neomucosa. We conclude that the technique of serosal patching is associated with impaired absorption in vivo. While this may be related, in part, to the minor motility changes observed, other factors such as hormonal changes may also be important.