V. Lymphatic Absorption in Simple Obstruction

Abstract

It is generally conceded that the content of the obstructed bowel is toxic as is also that of the unobstructed gut. The matter of abnormal absorption from the obstructed bowel is still the subject of considerable debate and speculation. The possible avenues through which toxic material may be absorbed from the bowel are: (1) the mesenteric veins, (2) the lymphatics, and (3) transperitoneally by diffusion through the bowel wall. It has been well established by many investigators that under conditions of obstruction, venous absorption, at any rate for substances absorbed from the normal bowel, is decreased. Transperitoneal absorption apparently does not occur unless there is gross damage to the bowel wall by distention with impairment of its viability. 1

In this study an attempt has been made to evaluate the occurrence of lymphatic absorption under conditions of simple intestinal obstruction and increased intra-enteric pressure. The absorption of dyes and of bacteria from the obstructed bowel was examined in the following manner:

Method and Results. Simple ileal obstruction was produced in 8 cats, and 20 cc. of 1% gentian violet or trypan blue was injected into the bowel above the site of obstruction. Such animals succumbed after 24-120 hours. At autopsy, 3 showed colored lymph nodes. Closed ileal loops were prepared in 12 cats, and the loops were distended with dye until the walls became tense (marked increase of intra-enteric pressure). Ten of the 12 cats at autopsy (24-72 hours) showed blue nodes. In several of these cats as the dye was being injected under pressure into the lumen of the bowel, the dye could be seen after 5 to 10 minutes to outline Peyer's patches in the wall and later the lymph vessels in the wall; finally, with continued pressure the lymph vessels of the mesentery to the regional lymph nodes were visualized.