Strangulation Obstruction and the Release of Strangulation. Effects of Fluid Administration on Mucosal Blood Flow and Damage

Kjell Ovrebo, Ellen Berget, Ketil Grong and Jonas Fevang

Department of Surgery, Haukeland University Hospital, Norway
Department of Pathology, Haukeland University Hospital, Norway
Department of Clinical Science, University of Bergen, Norway
Department of Orthopaedic Surgery, Haukeland University Hospital, Norway

^*Correspondance to: Kjell K Ovrebo 

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Abstract:

Background/
Purpose: This study evaluates bowel mucosa damage and the consequences of crystalloid fluid administration on mucosa damages upon release from strangulation obstruction. Secondary outcomes are metabolic and hemodynamic changes during and after release of strangulation obstruction.
Methods: Twenty-four anesthetized pigs were subject to strangulation of the distal ileum for 185 min. Variables and specimens were registered and collected during strangulation and for 25 min thereafter. Intravenous Ringer`s acetate infusion during strangulation obstruction and after release of strangulation was 15 mL·kg-1·h-1 in group I (Standard infusion) and 55 mL·kg-1·h-1 in group II (High infusion). Group III, (Sham) controls received 15 mL·kg-1·h-1 throughout the experiment.
Results: Strangulation obstruction reduced bowel blood flow from baseline averages of 2.9-3.8 ml·min-1·g-1 to 0.3-0.9 ml·min-1·g-1. Upon release of strangulation, the bowel blood flow remained low in the standard infusion group but increased significantly towards baseline levels in the high infusion group. Strangulation damaged more mucosa with standard infusion (80% ± 13%) than high infusion (25% ± 6%) (p=0.032). Release of strangulation had no significant effect on the mucosa (72% ± 17% and 41% ± 15% damage, respectively). Mucosal cell proliferation fell during strangulation from 169 mm-1 ± 17 mm-1 in controls to 71 mm-1 ± 16 mm-1 in standard (p<0.05) and 120 mm-1 ± 16 mm-1 in high infusion group. Release of strangulation significantly increased cell proliferation towards control levels. Serum base excess decreased significantly during strangulation and release of strangulation in both intervention groups. S-lactate increased significantly in blood from the strangulated loop, but only in peripheral blood of the standard infusion group.
Conclusion: Careful observation for hypotension, tachycardia and biochemical changes related to metabolic acidosis may contribute to early recognition of intestinal strangulation obstruction. Enhanced intravenous fluid administration reduces bowel damages and hemodynamic consequences of both strangulation and release of strangulation. Reperfusion damages should not be expected upon release of strangulation in the strangulated bowel and signs of bowel restitution appear early.

Keywords:

Animal model; Experimental model; Intestinal microcirculation; Mucosa; Reperfusion injury

Cite the Article:

Ovrebo K, Berget E, Grong K, Fevang J. Strangulation Obstruction and the Release of Strangulation. Effects of Fluid Administration on Mucosal Blood Flow and Damage. World J Surg Surgical Res. 2018; 1: 1031.