Abstract
In this provocative study the authors investigated whether intestinal permeability in preoperative patients correlated with changes in small intestinal histology and permeability. Forty-three patients (18 M, 25 F) aged 24 to 89 years (mean, 65 years) were studied. All patients were awaiting major abdominal surgery for the following diseases: colorectal cancer (n = 15), pancreatic cancer (n = 5), gastric cancer (n = 4), Crohn's disease (n = 4), ulcerative colitis (n = 3), diverticular disease (n = 3), and other (n = 9). No patient required total parenteral nutrition (TPN) or enteral nutrition support. "Subacute" obstruction was present in 18 patients (gastric outlet, intestinal, or colonic). Bacterial translocation was assessed by culture of a serosal biopsy taken from the antimesenteric border of the terminal ileum upon entering the abdomen and of a lymph node taken from the distal ileal mesentery. A simultaneous peripheral blood culture was taken. Histologic examination was performed on bowel removed from those patients who required small intestinal enterectomy. The villus height—total mucosal thickness ratio was measured using a measuring eyepiece on a light microscope. Intestinal permeability was measured 24 to 48 hours before surgery using the urinary lactulose (L)-rhamnose (R) excretion ratio. Subjects ingested L-rhamnose, 1 g, and lactulose, 5 g, and urine was collected for 5 hours.
Bacteria were cultured from the excised lymph node in 9 (20.9%) patients. Seven of nine of the organisms were Gram-negative intestinal flora, and the other two Gram-positive species were also intestinal flora. Three of these patients developed postoperative wound infections compared with one of the other 34 patients, although none became septic. Intestinal permeability was increased in 21 patients (L-R ratio> 0.05, n = 21), primarily on the basis of a significant increase in lactulose absorption. Bacterial translocation occurred in 5 (22.7%) of 22 patients with normal permeability and in 4 (19.0%) of 21 patients with increased permeability (p = .77). Data on villus height were not reported, but the villus height-total mucosal thickness ratio was similar in patients with and without bacterial translocation (0.55 ± 0.14 vs 0.62 ± 0.11).
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