Incidence of elevated serum amylase levels and pancreatitis after upper abdominal surgery

A group of 100 consecutive patients undergoing upper abdominal surgery at our hospital was evaluated during the postoperative period for elevation of the serum amylase level. Six patients in the group had significantly elevated serum amylase levels, and only one patient had clinical postoperative pancreatitis.     

Effects of truncal vagotomy on serum motilin levels, gastric motility patterns and gastric emptying: an experimental study

Using adult mongrel dogs, gastroduodenal motility, gastric emptying and pertinent serum motilin levels were measured under conscious states before and after transthoracic truncal vagotomy. Gastroduodenal motility was recorded by chronically planted strain gage transducers along the gastrointestinal tract. Gastric emptying was measured by X-ray examinations after barium-meat-meal ingestions or by gastric contents sampling method through the total pouch cannula after normal dog food ingestions. Results were as follows; Gastric motility patterns recorded by strain gage transducers were classified into two patterns that were a digestive pattern (D.P.) and an interdigestive pattern (I.P.). Serum motilin levels were elevated during high-amplitude contractions and lowered during resting phase of interdigestive periods. After vagotomy, strengths (heights) of antral contractions and phasic changes were decreased with the lack of I.P. These postvagotomy changes were thought to be related with the delayed gastric emptying after vagotomy. Gastric lavage through the cannula or pyloroplasty produced no effect on recovery of I.P. This fact suggested that the lack of I.P. was the direct effect of vagotomy and not due to delayed gastric contents emptying. On the assumption that motilin had the major role on the regulation of I.P., vagotomy seemed to produce an effect to prevent phasic motilin release.     

Intestinal ischemia complicating abdominal aortic surgery.

A 9-year experience with 2137 patients undergoing infrarenal abdominal aortic reconstruction was reviewed to determine both the incidence of intestinal ischemia and the clinical, anatomic, and technical factors associated with this complication of aortic surgery. A total of 24 (1.1%) patients had overt intestinal ischemia, documented by reoperation or endoscopic findings. Of these, colon ischemia occurred in 19 (0.9%) and small bowel ischemia developed in 5 (0.2%) patients. The incidence after elective operation for aneurysmal or occlusive disease did not differ, but patients with ruptured aneurysms and those undergoing reoperative procedures for total graft replacement were at higher risk. Preoperative angiography was most helpful in ascertaining risk. Ligation of a patent inferior mesenteric artery was the most common (74%) feature in patients with colon ischemia. With preexisting inferior mesenteric artery occlusion, impairment of collateral circulation was attributable to superior mesenteric artery disease, dissection or retractor injury, prior colon resection, or exclusion of hypogastric perfusion. Bloody diarrhea was the most frequent postoperative symptom and colonoscopy the most reliable means of diagnosis. One half of patients with colon ischemia required resection after late recognition of perforation. All cases of small bowel ischemia were related to superior mesenteric artery disease or injury or use of suprarenal clamping. The overall mortality rate was 25% but rose to 50% if bowel resection was required. Intestinal ischemia remains an infrequent but serious complication of aortic surgery. Despite a multifactorial cause, identification of patients at increased risk can lead to operative strategies to reduce its occurrence.     

Intestinal and multivisceral transplantation after abdominal trauma

SUMMARY: BACKGROUND Some trauma victims who survive acute illness develop lingering, debilitating syndromes that are incompatible with any semblance of normalcy. Intestinal failure, in particular, exacts a high price in terms of quality of life. Total parenteral nutrition (TPN) has served these patients well, but complications limit its long-term therapeutic effect. Consequently, transplantation is emerging as a life-saving therapy for some patients with the short gut syndrome.METHODS We reviewed eight adult and two pediatric recipients of intestinal and multivisceral transplants after severe abdominal trauma. Background demographics, type of abdominal trauma, transplant procedure, postoperative complications, and survival rates were appraised. This group was also compared with 47 nontrauma recipients of intestinal transplants performed during the same period.RESULTS Four patients (40%) died postoperatively (postoperative days 7, 53, 87, and 91) as a result of multiple organ failure after graft pancreatitis (n = 1), viral encephalitis (n = 1), and sepsis after severe rejection (n = 2). Six patients (60%) are alive (postoperative days 52-1,783). All are off TPN. The 4-year patient survival was 58%, with no significant difference between trauma and nontrauma patients.CONCLUSION Intestinal and multivisceral transplantation are viable options for the treatment of irreversible intestinal failure associated with severe trauma. Surviving patients are TPN independent and have a satisfactory quality of life.     

Plasma soluble interleukin-2 receptor levels during and after upper abdominal surgery

Soluble interleukin-2 (IL-2) receptor (sIL-2R) is reported to be up-regulated in inflammatory disorders. Although sIL-2R may modulate perioperative inflammatory responses, it remains unclear whether upper abdominal surgery affects plasma sIL-2R levels. We evaluated the influence of major abdominal surgery on plasma sIL-2R levels. Ten patients scheduled for upper abdominal surgery received anaesthesia with isoflurane, nitrous oxide, and epidural block. Plasma sIL-2R and IL-6 levels were determined at pre-anaesthesia, 0, 2, and 4 hours during surgery, and on postoperative days 1 (POD1) and 3 (POD3). The plasma levels of sIL-2R decreased significantly and achieved their minimum value at 4 hours (677.0 +/- 125.3 pg/ml, P < 0.01 compared to pre-anaesthesia value; 924.5 +/- 178.8 pg/ml, 95% confidence interval = 122.2-550.4). The plasma sIL-2R levels increased on POD1 (1336.5 +/- 174.0 pg/ml) and POD3 (1629.0 +/- 262.8 pg/ml), and reached a level significantly higher than the baseline (P < 0.05 and P < 0.001, 95% confidence interval = 93.4-730.6 and 402.8-1006.2, respectively). The plasma sIL-2R levels on POD3 significantly correlated with the peak IL-6 levels (r = 0.67, P < 0.05). The plasma sIL-2R levels on POD3 correlated with the amount of intraoperative bleeding (r = 0.66, P < 0.05). In conclusion, we found that major abdominal surgery induces characteristic changes in plasma soluble IL-2 receptor levels.     

Non-cardiac creatine kinase-B activity in serum after abdominal aortic bypass surgery

Serum creatine kinase (CK) and creatine kinase isoenzyme MB (CK-B) were measured and electrocardiogram (ECG) recorded preoperatively and 24, 48 and 72 hours and 7 days after abdominal aortic bypass grafting in ten patients. No ECG abnormality indicating acute myocardial infarction (AMI) appeared and no patient had chest pain. CK-B was below the discrimination value for AMI in all cases preoperatively, but increased significantly after the operation to a maximal median value of 15 (range 5-32) U/l at 48 hours. The time-activity curve of CK paralleled that of CK-B, reaching a maximal median value of 814 (range 289-1972) U/l at 48 hours. On day 7 CK and CK-B had normalized. The CK-B activity relative to CK activity remained below 6% in all patients. Elevated serum CK-B activity should be utilized with caution for the diagnosis of perioperative AMI in patients undergoing aortic bypass grafting.     

Chylothorax after abdominal surgery

Chylothorax is usually a complication of thoracic surgery procedures. Over a 5-year period we encountered three cases of chylothorax following abdominal surgery performed in general surgery units. The initial effusions, not lactescent, were ascribed to a pleural reaction that sometimes is observed during the postoperative period after abdominal surgery. Once the diagnosis was established, the initial conservative treatment failed, and surgery was necessary. In our patients, their debilitated physical condition precluded a thoracotomy approach. A video-assisted thoracoscopy procedure was undertaken, but the extensive pleural effusions, caused in part by the delay in the diagnosis, prevented the exact localization of the duct and its closure. Talc pleurodesis was successfully employed in all patients. Even after abdominal surgery, a persistent pleural effusion should always induce us to suspect a chylothorax.     

耳穴贴压改善家兔腹部术后胃肠功能的作用机制研究

目的 探讨耳穴贴压对腹部术后胃肠功能紊乱家兔模型的作用机制,为耳穴贴压治疗腹部术后胃肠功能紊乱提供参考。 方法 将30只SD清洁型家兔采用随机数字表法分为空白组、模型组、耳穴组各10只。耳穴组于造模成功后耳穴贴压胃、大肠、耳中穴,每日按压3次,每次每穴30 s,连续干预7 d;模型组进行造模手术未进行耳穴贴压;空白组不给予任何处理。 结果 耳穴组术后首次排便时间及肠鸣音恢复时间显著早于模型组（均P＜0.05）。三组术后6 h、3 d及7 d血清皮质醇浓度的干预效应、时间效应、交互效应显著,模型组及耳穴组术后6 h及3 d血清皮质醇浓度显著高于空白组,且术后3 d耳穴组显著低于模型组（均P＜0.05）。干预后,三组小肠推进率、C-kit蛋白阳性表达、iNOS活性有显著差异,其中耳穴组、空白组小肠推进率、C-kit蛋白阳性表达显著高于模型组,但iNOS活性显著低于模型组,耳穴组的C-kit蛋白阳性表达显著低于空白组（均P＜0.05）。 结论 耳穴贴压可缩短腹部术后家兔首次排便及肠鸣音恢复时间,降低血清皮质醇浓度及应激反应,有助于提升小肠推进率及结肠组织中C-kit蛋白阳性表达,促进腹部术后胃肠蠕动恢复。     

Intestinal intramural haemorrhage after blunt abdominal trauma

Intramural haemorrhage of the intestine following blunt trauma to the abdomen has been described in several clinical studies. Though such lesions may have an innocent appearance at primary laparotomy, they lead to delayed intestinal perforation in some cases. In previous experiments with similar lesions produced by penetrating abdominal missile, the histologic appearance and the clinical course were documented in pigs observed under long-term anaesthesia. In the present study anaesthetized pigs were submitted to blunt abdominal trauma in an impact machine, whereby the impact velocity could be regulated. The intra-abdominal pressure and the delivered impulse were recorded and the incidence and histologic appearance of intestinal injuries were observed at laparotomy immediately after the trauma. Intramural haemorrhage was found to occur when the impact velocity exceeded 5 m/s. At impact velocity 20 m/s, intestinal rupture occurred primarily. The observed intramural haemorrhages had the same histologic appearance as those seen after penetrating missile injury. The same clinical course, consequently, could be anticipated after blunt trauma.     

Postoperative hyperamylasemia in patients undergoing abdominal surgery: the relationship between serum and peritoneal amylase levels]

This study was undertaken to investigate the incidence of postoperative hyperamylasemia and amylase levels of intraperitoneal drainage in 106 patients undergoing major abdominal surgery. The results were as follows: 1. Postoperative hyperamylasemia was found in 36.8% of all patients, with higher incidence of hyperamylasemia being in accordance with greater surgical intervention to the pancreas. 2. The isoamylase pattern of postoperative hyperamylasemia was dominant in the salivary type. 3. The levels of such serum pancreatic enzymes as lipase, trypsin and elastase 1 were higher in the pancreatic-type group than in the salivary-type group, particularly with the elastase 1 levels being statistically higher in the former. 4. Increases in peritoneal amylase activity were found in those cases of greater surgical intervention to the pancreas, postoperative hyperamylasemia and higher serum pancreatic isoamylase levels. 5. Diagnosis of postoperative pancreatitis was confirmed in one case by clinical and laboratory findings and CT examination. It might be concluded that postoperative high peritoneal amylase levels suggest occurrence or possible occurrence of postoperative pancreatitis.     

Effects of morphine and tramadol on somatic and visceral sensory function and gastrointestinal motility after abdominal surgery.

BACKGROUND: Chronic nociceptive input induces sensitization and changes in regulatory reflexes in animal models. In humans, postoperative somatic and visceral sensitization and the secondary effects on reflex gut motility are unclear. METHODS: Somatic and visceral sensation and gastrointestinal motility were evaluated after abdominal hysterectomies in 50 patients who were randomized to receive double-blinded postoperative 48-h infusions of morphine or tramadol. Pain scores, rectal distension, skin electric sensation and pain tolerance thresholds, and gastrointestinal transit were assessed before and after operation, during and after analgesic infusions. RESULTS: Pain intensity scores decreased similarly with morphine and tramadol infusions (total doses, 66.8+/-20 mg and 732.4+/-152 mg [mean +/- SD], respectively). Skin pain tolerance thresholds in the incisional dermatome remained similar with morphine and tramadol throughout the study. During morphine infusions, pain tolerance thresholds on the shoulder increased (P<0.05) and then decreased after discontinuation on day 4 (P<0.02) compared with before operation. Rectal distension pain tolerance pressure thresholds increased after operation during morphine infusions (P<0.05). Similar but nonsignificant trends occurred with tramadol. Orocecal and colonic transit times increased after operation with both morphine and tramadol (P<0.005), but gastric emptying was prolonged only with morphine (P = 0.03). AU motility and sensory parameters had returned to preoperative levels by 1 month after operation. CONCLUSIONS: Pain control was equally effective with morphine and tramadol infusions. No somatic or visceral sensitization was evident during morphine and tramadol infusions, but pain tolerance thresholds as markers of antinociception were increased more during morphine infusions. The significant sensitization seen only after morphine discontinuation may be due to convergent visceral input. Gut motility was prolonged significantly by visceral surgery itself and also by morphine.     

Inflammatory response after abdominal surgery

Surgical manipulation of the gut elicits an inflammatory cascade within the intestinal muscularis that contributes to postoperative bowel dysmotility. A range of cytokines is sequentially released into the peritoneal fluid following abdominal surgery, their concentrations reflecting the magnitude of surgical trauma. The overproduction of inflammatory mediators might have detrimental effects on organ function and contribute to the enhanced risk of anastomotic leakage in the presence of sepsis. Specific cellular immune functions such as the microbicidal activity of peritoneal phagocytes are depressed after elective surgery, imposing a risk of infectious complications. Laparoscopic surgery decreases the local and systemic production of cytokines and acute-phase reactants, and better preserves peritoneal immunity compared with open surgery. As concluded from animal studies, the gas used for the pneumoperitoneum may possess substantial immunomodulatory activity.     

Gas gangrene after abdominal surgery

This is a report on nine cases of gas-gangrene which developped after abdominal surgery. In five patients the diagnosis was made at the bedside, three of these patients survived. Cardinal symptoms were rapid deterioration of the general condition, severe pain around the incision, tachycardia, and the appearance of jaundice along with a fall of the hemoglobin.