Clinicopathological evaluation of anoxic mucosal injury in strangulation ileus

BMC Surgery

Research Article

Tatsuyuki Kakuma¹  Jun Taguchi²  Sugako Kajiwara³  Ichirou Shima⁴  Ryuji Takahashi⁵  Yoshito Akagi⁵  Tomoaki Mizobe⁵  Kazuo Shirouzu⁵  Atsushi Kaibara⁶  Takaho Tanaka⁶ 

[1] Department of Biostatistics Center, Kurume University, Kurume, Japan;Department of Pathology, Asakura Medical Association Hospital, Asakura, Japan;Department of Pathology, Social Insurance Tagawa Hospital, Tagawa, Japan;Department of Surgery, Asakura Medical Association Hospital, Asakura, Japan;Department of Surgery, Kurume University School of Medicine, Kurume, Japan;Department of Surgery, Social Insurance Tagawa Hospital, Tagawa, Japan;

关键词: Strangulation ileus;    Anoxic injury;    Mucosal injury;    Creatine kinase;    Base excess;   

DOI  :  10.1186/1471-2482-14-79

 received in 2013-05-23, accepted in 2014-10-07,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundIn 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.MethodsWe 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.ResultsResected 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.ConclusionIn 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.

【 授权许可】

CC BY   
© Takahashi et al.; licensee BioMed Central Ltd. 2014