Effect of intraoperative PEEP application on colonic anastomoses healing: An experimental animal study

PURPOSE

This study aimed to assess the effect of intraoperative PEEP intervention on the healing of colonic anastomoses in rabbits.

MATERIALS AND METHODS

Thirty-two New Zealand type male rabbits were divided into two groups of sixteen animals each. Following ventilation with tracheostomy, colonic resection and anastomosis were performed in both groups. While 10 cm H2O PEEP level was applied in Group I (PEEP), Group II (ZEEP) was ventilated without PEEP throughout the surgery. Half of the both PEEP and ZEEP group animals were killed on the third postoperative day, while the remaining half on the seventh. Anastomotic bursting pressures, the tissue concentrations in hydroxyproline, and histological assessments were performed. Besides, intraoperative oxygen saturation and postoperative arterial blood gas parameters were also compared.

RESULTS

On the first postoperative day, both arterial oxygen tension (PO2) and oxygen saturation (SO2) in the PEEP group were significantly higher than in the ZEEP group. On the seventh postoperative day, the bursting pressures of the anastomoses were significantly higher in the PEEP group, however the hydroxyproline content was significantly lower in the PEEP group than that in the ZEEP group. At day 7, PEEP group was significantly associated with increased neoangiogenesis compared with the ZEEP group.

CONCLUSION

The anastomotic healing process is positively influenced by the intraoperative PEEP application.

Development of two cancers in the same patient after ileorectal and ileal pouch anal anastomosis for familial adenomatous polyposis

OBJECTIVE

To report a case of a patient with familial adenomatous polyposis.

CLINICAL PRESENTATION AND INTERVENTION

A 36-year-old male patient who suffered from rectal bleeding was treated with colectomy and ileorectal anastomosis for familial adenomatous polyposis (FAP) in 1974. After 19 years, in situ adenocarcinoma was detected in the rectal stump. Completion proctectomy, mucosectomy, and hand-sewn ileal pouch anal anastomosis with protective ileostomy were performed. In 2002, a metachronous cancer was detected at the anastomosis and abdominoperineal resection of the pouch and end ileostomy were performed. Later on, the perineum was excised locally because of cancer recurrence.

CONCLUSION

This case shows that lifetime surveillance of the FAP patients after surgery is crucial.

Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions

BACKGROUND/AIMS

The aim of this study was to evaluate the accuracy of endoscopic ultrasonography (EUS) and consistency of the EUS findings with histopathologic examination.

METHODS

EUS was performed in 90 patients with upper gastrointestinal tract submucosal tumors, followed in Turkiye Yuksek Ihtisas Hospital, Gastroenterology Clinic. Histopathological diagnosis and EUS findings of 25 of 90 patients were compared.

RESULTS

48.9% of the lesions were found to have arisen from muscularis propria, 33.3% from submucosa, 6.6% from mucosa and 10% from muscularis mucosae, and 1.2% from serosa of the 90 patients. In 25 patients histopathologic confirmation was done. 24% of 25 patients were leiomyoma, 20% polyp, 12% lipoma and the remainder were teratoma, carcinoid tumor, adenocarcinoma, polyp and leiomyosarcoma. EUS was successful in detecting all tumors. EUS diagnosis was consistent with histopathogical diagnosis in all patients with EUS findings as leiomyosarcoma (n=2) and polyp (n=6), in 46.2% of patients with EUS findings as leiomyoma, and in 50% of those with lipoma.

CONCLUSIONS

EUS is an accurate means of evaluating and diagnosing submuocal lesions of the gastrointestinal tract.

Polyarteritis nodosa presenting with necrotising appendicitis and hepatic aneurysm rupture

Polyarteritis nodosa is a necrotizing vasculitis which affects small and medium-sized arteries. The clinical features of the disease vary according to the site and extent of involvement. Aneurysmal dilatation and thrombosis in the arteries of the liver and gastrointestinal tract have been reported in polyarteritis nodosa. However, rupture of the hepatic aneurysm and necrotizing appendicitis due to polyarteritis nodosa are uncommon; indeed a case in which these have occurred together has not been reported to date. In this case report, a patient with necrotizing appendicitis and hepatic aneurysm rupture due to underlying poliarteritis nodasa is presented. Extensive intraabdominal hematoma and appendicitis were treated surgically and complete recovery was achieved.

The effect of recombinant growth hormone on intestinal anastomotic wound healing in rats with obstructive jaundice

BACKGROUND/AIMS

Several clinical and experimental studies have shown that obstructive jaundice delays wound healing. Growth hormone may prevent delayed wound healing, since it has effects on the release of mediators in jaundice, as well as increasing the protein synthesis.

METHODS

Forty male Wistar rats were allocated to four groups: Group I (n=10): intestinal anastomosis to normal small bowel, Group II (n=10): intestinal anastomosis to normal small bowel followed by growth hormone therapy (2mg/kg/day, subcutaneously), Group III (n=10): intestinal anastomosis to obstructive jaundice rat's small bowel, Group IV (n=10): intestinal anastomosis to obstructive jaundice rat's small bowel followed by growth hormone therapy at the same dosage The animals were observed for seven days then killed. Intraabdominal adhesions, anastomotic complications and anastomotic bursting pressures were recorded and tissue samples from the anastomotic site were obtained to measure hydroxyproline levels and for histopathologic examination.

RESULTS

Growth hormone had a beneficial effect on the healing of intestinal anastomosis in both jaundiced and non-jaundiced rats. This was demonstrated by clinical and mechanical parameters such as a significant increase in anastomotic bursting pressure, hydroxyproline content and histopathological scores.

CONCLUSION

Growth hormone reverses the adverse effects of obstructive jaundice on small bowel anastomotic healing. It can be hypothesized that this effect is due to augmentation of insulin-like growth factors, protection of hepatocytes, enhancement of intestinal epithelization, and reversal of the resultant malnutritional state caused by growth hormone in obstructive jaundice.