[Morphometrical investigations on bowel interpositions after total gastrectomy (author's transl)]

Different types of interposition were performed on beagle dogs as stomach substitutes after total gastrectomy: (1) interposition of jejunal segment, (2) interposition of ileocecal region, (3) interposition of colon segment, and (4) jejunal segment according to Roux-en-Y configuration. The interpositions were evaluated morphometrically at defined sites 3 months after the operation. One of the most evident changes found in the interposed intestinal segment was strong hypertrophy of the circular muscular layer. In interposed colon segment the hypertrophy was less than in jejunal ones. The volume burden the newly formed stomach exposed to seems to be the pathogenetic factor responsible for this change. A change in villous morphology was shown with a reduction of the surface of the intestinal mucosa. Simultaneous enlargement of crypts presented a picture similar to the partial mucosal atrophy of the hyperregenerative type. In contrast, the mucosa of the colon interpositions was regular and showed no evident structural change. The alterations of the small intestinal mucosa seem to be induced mainly by differences in the intraluminal milieu. Besides the volume burden insufficient chyme digestion may be responsible for local malnutrition of the mucosa, which results in a morphological change. The hypertrophy of the muscular layer can be interpreted as adaptation to the reservoir function and the degeneration of small intestinal mucosa, as caused by trophic interference.