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Hydrophilic Polymer-associated Ischemic Enterocolitis.

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Hydrophilic polymer coatings on medical devices can cause ischemic enterocolitis. Degrading polymers in submucosal vessels lead to gastrointestinal injury, a new diagnostic entity.

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Area of Science:

  • Gastroenterology
  • Pathology
  • Biomaterials Science

Background:

  • Hydrophilic polymer coatings lubricate medical devices but can fragment.
  • Dislodged coating particles may cause downstream thromboembolic complications.
  • Previous reports implicated these fragments in injuries to the brain, heart, lung, and skin.

Purpose of the Study:

  • To describe hydrophilic polymer-associated ischemic enterocolitis.
  • To report the incidence of this condition in patients undergoing bowel resection.
  • To characterize the morphology and diagnostic features of the polymers.

Main Methods:

  • Retrospective review of 7 gastrointestinal specimens from 3 patients with ischemic bowel resection.
  • Histologic examination of polymers within submucosal vessels.
  • Analysis of polymer morphology, foreign body giant cell reaction, and special stain characteristics.
  • Clinical follow-up of affected patients.

Main Results:

  • Identified hydrophilic polymer fragments in submucosal vessels of ischemic bowel resections (4% incidence).
  • Polymers appeared as basophilic, intravascular, serpiginous structures.
  • Polymers showed altered morphology over time and with graft type, associated with giant cell reaction. Special stains aided identification.
  • Identical polymers found in aortic thrombus in a patient with paralysis.

Conclusions:

  • Hydrophilic polymer-associated ischemic enterocolitis is a newly recognized diagnostic entity.
  • It should be considered in the differential diagnosis of iatrogenic gastrointestinal ischemia.
  • Awareness prevents misdiagnosis as parasitic infection, vasculitis, sarcoidosis, or inflammatory bowel disease.