Our Summary

This research paper discusses a study carried out on pigs, where a small area (3-4 cm) of the small intestine was made ischemic, i.e., its blood supply was clamped off for a period of 1 to 6 hours. The aim was to observe how the levels of lactate (a substance produced when oxygen levels are low) changed over time in the capillary blood from this area.

Blood samples were taken every hour from different areas, including the center of the ischemic area, the margins of the resection, and vascularized zones. The lactate levels in these samples were measured using a handheld device, and tissue samples were also taken to assess the activity of mitochondria (the part of a cell responsible for energy production).

The results showed that the lactate levels were significantly higher in the ischemic area compared to the healthy, vascularized areas. Interestingly, after just one hour, the lactate levels at the margins of the resection were higher than those in the vascularized areas, suggesting that visual assessment alone isn’t enough to accurately determine the perfusion status. However, after 2 to 6 hours, there was no difference in lactate levels between these areas. The study also found that maximal tissue respiration decreased significantly after one hour in the ischemic area.

In addition to lactate, the study also found significant changes in the levels of other metabolites (substances involved in metabolism) between the different areas.

In conclusion, this study suggests that measuring lactate levels could provide a useful way to accurately assess the local blood supply status in the bowel.

FAQs

  1. What does the study aim to assess in relation to bowel hypoperfusion?
  2. How were capillary lactates measured in the study?
  3. What conclusions were drawn from the study about capillary lactates and local bowel perfusion status?

Doctor’s Tip

A helpful tip a doctor might tell a patient about bowel resection is to closely monitor their bowel function post-surgery. This includes paying attention to changes in bowel movements, abdominal pain, and any signs of infection. It is important to follow a proper diet and stay hydrated to promote healing and prevent complications. Additionally, it is crucial to attend all follow-up appointments with the surgeon to ensure proper recovery and address any concerns.

Suitable For

Patients who are typically recommended bowel resection include those with:

  1. Bowel ischemia or infarction: Patients with compromised blood supply to the bowel, which can lead to tissue damage and necrosis, may require bowel resection to remove the affected area.

  2. Bowel obstruction: Patients with a blockage in the bowel, such as from a tumor or adhesion, may need bowel resection to remove the obstruction.

  3. Inflammatory bowel disease: Patients with conditions like Crohn’s disease or ulcerative colitis may require bowel resection to remove diseased portions of the bowel and alleviate symptoms.

  4. Trauma: Patients who have experienced significant trauma to the bowel, such as from a gunshot or stab wound, may need bowel resection to repair the damage.

  5. Diverticulitis: Patients with severe diverticulitis, an inflammation or infection of small pouches that form in the colon, may require bowel resection to remove the affected area.

Overall, bowel resection may be recommended for a variety of conditions that affect the bowel and cannot be effectively treated with other interventions.

Timeline

Before bowel resection:

  1. Patient presents with symptoms such as abdominal pain, bloating, changes in bowel habits, and/or rectal bleeding.
  2. Patient undergoes diagnostic tests such as imaging studies and colonoscopy to confirm the need for bowel resection.
  3. Patient may be prescribed bowel preparation to cleanse the colon before surgery.
  4. Patient undergoes pre-operative evaluation and preparation for surgery.

After bowel resection:

  1. Patient undergoes surgery to remove the diseased portion of the bowel.
  2. Patient is monitored closely in the post-operative period for complications such as infection, bleeding, and bowel obstruction.
  3. Patient may require pain management and intravenous fluids in the immediate post-operative period.
  4. Patient gradually resumes oral intake and is monitored for bowel function and the passage of gas and stool.
  5. Patient is discharged from the hospital once they are able to tolerate oral intake and their bowel function has returned to normal.
  6. Patient may require follow-up appointments with their healthcare provider to monitor their recovery and address any concerns or complications.

What to Ask Your Doctor

  1. How will the bowel resection procedure be performed?
  2. What are the potential risks and complications associated with bowel resection?
  3. What is the expected recovery time after bowel resection?
  4. Will I need a temporary or permanent colostomy or ileostomy after the procedure?
  5. What dietary changes or restrictions will I need to follow after bowel resection?
  6. How will bowel function be affected after the surgery?
  7. Are there any specific medications or supplements I should take before or after the procedure?
  8. How will bowel resection affect my overall health and quality of life in the long term?

Reference

Authors: Diana M, Noll E, Diemunsch P, Moussallieh FM, Namer IJ, Charles AL, Lindner V, Agnus V, Geny B, Marescaux J. Journal: Surg Innov. 2015 Oct;22(5):453-61. doi: 10.1177/1553350615598620. Epub 2015 Aug 5. PMID: 26250483