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ORIGINAL ARTICLE
Year : 2007  |  Volume : 12  |  Issue : 1  |  Page : 25-27
 

Interposition of the demucosed colon segment into the small bowel


1 Department of Pediatric Surgery, SSK Children's Hospital, Turkey
2 Pedicer Pediatric Surgery Center, Turkey
3 Department of Histology and Embryology, Uludag University Hospital, Turkey
4 Animals' Hospital of Municipality of Bursa, Bursa, Turkey

Correspondence Address:
M Sanal
Anichstr. 35 Kinderchirurgie 3N 6020 Innsbruck, Austria

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.31085

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   Abstract 

The aim of this study is, could we transform demucosed colon into the small bowel? To find the answer, this study was investigated the surface changes of demucosed colon segment, interposed into the small bowel fashioned as a blind loop. This study was performed in five healthy young stray dogs. A blind loop was fashioned, using a 5 cm long demucosed colonic segment and a 20 cm long ileal segment. Ileal and colonic continuity were restored by primary anastomosis. Four weeks later, blind loop was resected and examined histologically under light microscopy. Histological findings revealed that demucosed colonic segment interposed into the small bowel fashioned as a blind loop, was covered with small bowel epithelium.


Keywords: Colon interposition, short bowel syndrome


How to cite this article:
Sanal M, Sinmaz K, Sunay F B, Çavusoglu I, Büyükçoban M. Interposition of the demucosed colon segment into the small bowel. J Indian Assoc Pediatr Surg 2007;12:25-7

How to cite this URL:
Sanal M, Sinmaz K, Sunay F B, Çavusoglu I, Büyükçoban M. Interposition of the demucosed colon segment into the small bowel. J Indian Assoc Pediatr Surg [serial online] 2007 [cited 2020 Feb 22];12:25-7. Available from: http://www.jiaps.com/text.asp?2007/12/1/25/31085



   Introduction Top


Short bowel syndrome (SBS) is the given term to the complex malabsorption problem associated with inadequate intestinal absorptive surface.[1]

Different strategies have been employed for the treatment of SBS. The surgical therapies aimed; slowing the intestinal transit time - increasing the absorptive surface - and small bowel transplantation.[1],[2]

There are many surgical approaches in SBS. Could we transform demucosed colon into the small intestine? To find the answer of this question, we investigated the surface changes of the demucosed colon segment, which interposed into the small bowel fashioned as a blind loop.


   Materials and Methods Top


The study was performed in five healthy young stray dogs weighed 8-10 kg, aged 6-8 months. They were kept in quarantine for 3 weeks.

The study was officially approved by the authorities in compliance with the protection of law of animals. All operations were used under general anesthesia by a veterinarian under steril conditions in the Animal Hospital Nilüfer - Bursa. Neither hazardous procedures nor chemicals are involved in this study.

Dogs were allowed to drink only water for 3 days before the operation. General anesthesia was performed with xylasine (10 mg/kg) and ketamine (6-8 mg/kg).

The abdomen was opened through a midline incision; a 5 cm pedicled segment of transverse colon was prepared. Saline solution was injected between the mucosal and muscular layers for facilitating demucosation. Mucosa was easily stripped from the muscular layer with blunt dissection. A 20 cm ileal segment was isolated from the middle portion of the ileum with its mesentary. A blind loop was created using the demucosed colon and the isolated ileal segment.

3-5 mm of the denuded colonic coat was spared for histological examination as control [Figure - 1]A.

Ileal and colonic continuity were restored by primary anastomosis. The post-operative period was uneventful. Animals were isolated in separate cages after the operation and were given analgesics. They were allowed to drink only water on the first post-operative day and fed with soft food starting from the second day.

Dogs were re-operated on the post-operative 4th week. Blind loop was resected and abdomen was closed. Tissue specimens were fixed in 10% neutral formalin solution, stained with Hematoxylene-Eosine (H/E) and investigated under light microscope.


   Results Top


The histology of the normal colon is shown in [Figure - 1]A. Histological examination of the denuded colon at the start of the study showed muscular coat without any trace of tunica mucosa, muscularis mucosa, and sub-mucosa [Figure - 1]B.

At the end of the study, after 4 weeks, it was considered unnecessary to sacrifice the dogs and they were returned to their environment of the animals' hospital.

The pedicled blind loop was dilated and filled with mucosal secretion. The denuded colonic segment was contracted like a ring causing some degree of obstruction. The surface of the demucosed colonic coat was totally covered by granulation tissue. Monolayer cubic epithelial cells and intestinal glands were found within this granulation tissue, located mainly near the anastomosed ends [Figure - 2].


   Discussion Top


Colon interposition is one of the various surgical techniques for the treatment of SBS.[1]

The interposition of such segments improve lifestyle by, increasing the transit time and diminishing the number of diarrhea episodes.[3] Fatal intestinal obstruction is an undesired side effect, seen with the antiperistaltic colon segment.[4],[5]

The length of the inter-positioning colon segment is a matter of debate. Authors have utilized segments of colon ranging from 3 to 24 cm. [1],[2],[3],[4],[5],[6],[7] For technical reasons and to preserve normal colon as much as possible, we preferred to use 5 cm in our model.

In some studies, significant increase of the thickness of intestinal wall is reported that colonic segment contracts like a ring and obstructs the passage.[3]

We have also observed the same changes in our model. Using an intraluminal stent may prevent such an obstruction.

Some previous studies have shown that the neomucosa of the denuded colonic segment resemble colonic mucosa rather than small bowel's.[1],[8]

This may be because of the inadequate removal of the colonic mucosa.

We removed the colonic mucosa totally and confirmed histologically that no remnant was left [Figure - 1]B. Covering the entire colonic muscular matrix with granulation tissue is a prominent finding that we encountered. The neomucosa formed by monolayer cubic epithelial cells and intestinal glands originated from small bowel epithelium [Figure - 2].

Even Zachariou's study showed typical characteristics of the small bowel mucosa as villi and crypts in the 6th week after transplantation.[2]

After these findings, we think that, small bowel epithelium the demucosed colonic coat as neomucosa covered. Further detailed studies are required to understand whether this segment has absorbtive capacity similar to that of the small intestine.


   Acknowledgments Top


We would like to thank to veterinarian Dr. Mürsel Büyükηoban, Director of the Animals' Hospital Nilüfer - Bursa for his contribution in our study.

 
   References Top

1.Banerjee AK, Chadwick SJ, Peters TJ. Adaptation of jejunal to colonic mucosal autografts in experimentally induced short bowel syndrome. Dig Dis Sci 1990;35:340-8.  Back to cited text no. 1  [PUBMED]  
2.Zachariou Z, Daum R, Beiler HA, Gorgas K. Autogenic allotopic small-bowel mucosa transplantation in beagles. A new perspective for treatment of small-bowel syndrome? Eur J Ped Surg 1998;8:230-3.   Back to cited text no. 2    
3.Taha MO, Riberia MA Jr, de Oliviera Games P, Montero Frasson E, Plapler H, Ferreira R, et al . Evaluation of the longitudinal musculature of segments of the distal colon interposed following extended jejunum-ileum resection. Microsurgery 1999;19:306-10.  Back to cited text no. 3    
4.Lloyd DA. Antiperistaltic colon interposition following massive small bowel resection in rats. J Pediatr Surg 1981;16:64-9.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Sidhu GS, Narasimharao KL, Usha Rani V, Sarkar AK, Mitra SK. Absorption Studies after massive small bowel resection and antiperistaltic colon interposition in Rhesus Monkeys. Digest Dis Sci 1985;30:483-8.  Back to cited text no. 5  [PUBMED]  
6.Carner DV, Raju S. Failure of antiperistaltic colon interposition to ameliorate short bowel syndrome. Am Surg 1981;47:538-40.  Back to cited text no. 6  [PUBMED]  
7.Garcia VF, Templeton JM, Eichelberger MR, Koop CE, Vinograd I. Colon interposition for the short bowel syndrome. J Pediatr Surg 1981;16:994-5.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Watson LL, Freidman HI, Griffin DG, Norton LW, Mellick PW. Small bowel neomucosa. J Surg Res 1980;28:280-91.  Back to cited text no. 8    


    Figures

[Figure - 1], [Figure - 2]



 

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    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    Acknowledgments
    References
    Article Figures

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