Corticosteroid therapy in regional small bowel ischaemia

Corticosteroid therapy in pharmacological doses has a well documented positive effect in shock caused by severe intestinal ischaemia. In this study the effect of high doses of corticosteroids on the exchange circulation of the mucosa was analysed in varied, regional small bowel ischaemia. Thirty minutes after establishment of moderate ischaemia the exchange circulation in the mucosa of the ischaemic intestinal segment in animals treated with 100 mg/kg hydrocortisone showed no improvement compared with untreated animals. Higher corticosteroid doses impaired the exchange circulation. On analysis 7 days after establishment of the ischaemia, treatment with 100 mg/kg hydrocortisone during the first 3 days was found to have impaired the exchange circulation. The same treatment in rats with more severe intestinal ischaemia gave a greatly increased mortality. Possible reasons for the impaired mucosal circulation following corticosteroid therapy in pharmacological doses in regional small bowel ischaemia are discussed. One possibility is that corticosteroids induce a "steal syndrome" due to the better vasodilative effect on healthy than on ischaemic intestinal tissue.