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The influence of small bowel contamination on the pathogenesis of bowel obstruction
1Pediatric Surgical Clinic, University Children's Hospital, Zurich, Switzerland.
Abstract:
Altered motility of the intestine after laparotomy, adynamic bowel segments, blind bowel loops following bypass operations, or diverticula may cause pathological growth of intestinal microflora and thus lead to contaminated small bowel syndrome (CSBS). As a result of malabsorption in the jejunum and ileum, loss of weight, growth arrest, diarrhea, steatorrhea, megaloblastic anemia, and hypoproteinemia may occur. In addition to these, the acute symptoms of small bowel contamination, intestinal obstruction and secretory diarrhea, are less well known. A stenosis in the terminal ileum was experimentally created in Göttingen minipigs and the bacterial flora of the small bowel assessed by quantitative cultures. After 3 months the number of aerobic and anaerobic bacteria in the pre- and poststenotic region had increased by a factor of 10(2)-10(5). The acute form of CSBS was diagnosed by microbiological examination of gastric samples in 14 children. After the children were treated with orally and intravenously administered antibiotics, the symptoms disappeared within 12-36 h. Reoperations for small bowel obstruction can be avoided by conservative treatment of CSBS with antibiotics.
Insights
Contaminated small bowel syndrome (CSBS) involves bacterial overgrowth causing malabsorption and diarrhea. Antibiotic treatment effectively resolves acute CSBS symptoms in children, potentially preventing surgery.
Area of Science:
- Gastroenterology
- Microbiology
- Surgical Pathology
Background:
- Altered intestinal motility can lead to pathological growth of intestinal microflora, resulting in contaminated small bowel syndrome (CSBS).
- CSBS can cause malabsorption, leading to symptoms like weight loss, diarrhea, steatorrhea, megaloblastic anemia, and hypoproteinemia.
- Acute symptoms of small bowel contamination, including intestinal obstruction and secretory diarrhea, are less recognized.
Purpose of the Study:
- To investigate the effects of experimentally induced ileal stenosis on small bowel bacterial flora in Göttingen minipigs.
- To diagnose and evaluate the efficacy of antibiotic treatment for acute contaminated small bowel syndrome in children.
Main Methods:
- Experimental creation of terminal ileum stenosis in Göttingen minipigs.
- Quantitative cultures to assess small bowel bacterial flora before and after stenosis.
- Microbiological examination of gastric samples for diagnosing acute CSBS in children.
- Treatment of children with oral and intravenous antibiotics.
Main Results:
- In minipigs, ileal stenosis led to a 10^2-10^5 fold increase in aerobic and anaerobic bacteria in the pre- and poststenotic regions after 3 months.
- Acute CSBS was diagnosed in 14 children via microbiological examination.
- Antibiotic treatment resulted in symptom resolution within 12-36 hours in these children.
Conclusions:
- Experimental ileal stenosis causes significant bacterial overgrowth in the small bowel.
- Antibiotic therapy is an effective conservative treatment for acute contaminated small bowel syndrome in children.
- Conservative antibiotic management of CSBS may help avoid reoperations for small bowel obstruction.