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Surgical manipulation of the small intestine and its effect on the lung
Simmy Thomas1, Swapnil Karnik, K A Balasubramanian
1The Wellcome Trust Research Laboratory, Department of Gastrointestinal Sciences, Christian Medical College Hospital, Vellore, India.
Background:
Surgical manipulation of the intestine results in generation of oxygen free radicals leading to mucosal damage as evidenced by ultrastructural and biochemical changes. It is likely that the gut-derived mediators can bring about damage to distant organs such as the lung.
Methods:
Surgical manipulation of the gut was performed by opening the abdominal wall and handling the intestine. Lung damage was assessed by histology, markers of oxidative stress, and protein content in bronchoalveolar lavage fluid. Protection offered by pretreatment with various compounds such as allopurinol, L-arginine, quinacrine, and indomethacin was also studied.
Results:
Gut manipulation resulted in neutrophil infiltration, oxidative stress, and permeability changes in the lung and these changes were maximum 30 and 60 min following surgical manipulation, which recovered with time and reversed to normal by 24 h. Prior treatment with inhibitors of xanthine oxidase, phospholipase A(2), or cyclooxygenase showed a protective effect against lung damage.
Conclusion:
This study has shown that laparotomy and intestinal handling result in distant organ (lung) damage which is probably brought about by neutrophil infiltration and oxidative stress on the lung. This is likely mediated by compounds generated in the intestine and transported into the systemic circulation since inhibition of generation of chemical mediators in the intestine offers protection against lung damage.
Insights
Surgical manipulation of the intestine causes lung damage via oxidative stress and neutrophil infiltration. Inhibiting specific chemical mediators in the gut can protect the lungs from this damage.
Area of Science:
- Surgical research
- Organ injury mechanisms
- Inflammatory response
Background:
- Intestinal surgery generates oxygen free radicals, causing mucosal damage.
- Gut-derived mediators may induce damage in distant organs, like the lungs.
Purpose of the Study:
- To investigate lung damage following intestinal manipulation.
- To assess the protective effects of pre-treatment with various compounds.
Main Methods:
- Surgical manipulation of the gut was performed.
- Lung damage assessed via histology, oxidative stress markers, and bronchoalveolar lavage fluid.
- Evaluated protection from allopurinol, L-arginine, quinacrine, and indomethacin pre-treatment.
Main Results:
- Gut manipulation led to lung neutrophil infiltration, oxidative stress, and permeability changes peaking at 30-60 minutes.
- These lung changes resolved within 24 hours.
- Pre-treatment with xanthine oxidase, phospholipase A(2), or cyclooxygenase inhibitors protected against lung damage.
Conclusions:
- Laparotomy and intestinal handling cause distant lung damage mediated by neutrophil infiltration and oxidative stress.
- This damage is likely caused by gut-generated compounds entering circulation.
- Inhibiting intestinal mediator generation protects against lung damage.