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. 2014 Dec 21;20(47):17905-13.
doi: 10.3748/wjg.v20.i47.17905.

Protective effects of terminal ileostomy against bacterial translocation in a rat model of intestinal ischemia/reperfusion injury

Zhi-Liang Lin  1 , Wen-Kui Yu  1 , Shan-Jun Tan  1 , Kai-Peng Duan  1 , Yi Dong  1 , Xiao-Wu Bai  1 , Lin Xu  1 , Ning Li  1
Affiliations

Protective effects of terminal ileostomy against bacterial translocation in a rat model of intestinal ischemia/reperfusion injury

Zhi-Liang Lin et al. World J Gastroenterol. .

Abstract

Aim: To investigate the effects of terminal ileostomy on bacterial translocation (BT) and systemic inflammation after intestinal ischemia/reperfusion (I/R) injury in rats.

Methods: Thirty-two rats were assigned to either the sham-operated group, I/R group, I/R + resection and anastomosis group, or the I/R + ileostomy group. The superior mesenteric artery was occluded for 60 min. After 4 h, tissue samples were collected for analysis. BT was assessed by bacteriologic cultures, intestinal permeability and serum levels of endotoxin; systemic inflammation was assessed by serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10, as well as by the activity of myeloperoxidase (MPO) and by intestinal histopathology.

Results: Intestinal I/R injury not only caused morphologic damage to ileal mucosa, but also induced BT, increased MPO activity and promoted the release of TNF-α, IL-6, and IL-10 in serum. BT and ileal mucosa injuries were significantly improved and levels of TNF-α and IL-6 in serum were decreased in the I/R + ileostomy group compared with the I/R + resection and anastomosis group.

Conclusion: Terminal ileostomy can prevent the detrimental effects of intestinal I/R injury on BT, intestinal tissue, and inflammation.

Keywords: Bacterial reflux; Bacterial translocation; Intestinal ischemia/reperfusion; Terminal ileostomy.

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Figures

Figure 1
Figure 1
Experimental design. I/R: Ischemia/reperfusion; RA: Resection and anastomosis.
Figure 2
Figure 2
Wet-to-dry weight ratios. Data are expressed as mean ± SD. aP < 0.01 vs sham; bP < 0.01 vs I/R + RA. I/R: Ischemia/reperfusion; RA: Resection and anastomosis.
Figure 3
Figure 3
Fluorescein isothiocyanate-dextran levels in serum. Data are expressed as mean ± SD. aP < 0.01 vs sham. FITC: Fluorescein isothiocyanate; I/R: Ischemia/reperfusion; RA: Resection and anastomosis.
Figure 4
Figure 4
Endotoxin levels in serum. Data are expressed as mean ± SD. aP < 0.01 vs sham; bP < 0.01 vs I/R + RA. I/R: Ischemia/reperfusion; RA: Resection and anastomosis.
Figure 5
Figure 5
Serum levels of tumor necrosis factor tumor necrosis factor-α, -6 and IL-10 following intestinal ischemia/reperfusion injury in rats. Data are expressed as mean ± SD. aP < 0.01 vs sham; bP < 0.01 vs I/R + RA group. IL: Interleukin; TNF-α: Tumor necrosis factor-α; I/R: Ischemia/reperfusion; RA: Resection and anastomosis.
Figure 6
Figure 6
Myeloperoxidase activity in distal ileal tissue. Data are expressed as mean ± SD. aP < 0.05 vs sham; bP < 0.05 vs I/R + RA group. I/R: Ischemia/reperfusion; RA: Resection and anastomosis; MPO: Myeloperoxidase.
Figure 7
Figure 7
Light microscopic evaluation of the distal ileum. Hematoxylin and eosin staining in distal ileum (magnification × 40) in the A: sham-operated group, showing an intact mucosal barrier with normal lamina propria; B: Intestinal ischemia/reperfusion (I/R) injury resulted in acute mucosal damage; C: Resection and anastomosis did not ameliorate the mucosal damage caused by I/R injury; D: I/R + ileostomy resulted in an apparently intact mucosal barrier, though the epithelial cells appeared shrunken.
Figure 8
Figure 8
Histologic injury score of the intestines. Data are expressed as mean ± SD. aP < 0.01 vs sham. I/R: Ischemia/reperfusion; RA: Resection and anastomosis.
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