THE INFLUENCE OF ISCHEMIC BOWEL WALL DAMAGE ON TRANSLOCATION, INFLAMMATORY RESPONSE, AND CLINICAL COURSE

BACKGROUND: While vascular patency and overall viability of the gut ca n be evaluated perioperatively, damage to the mucosal barrier can hard ly be judged in the perioperative setting and, moreover, will probably determine the clinical course. METHODS: In 19 consecutive cases with intestinal ischemia, the clinical course was correlated to the severit y of the disease (APACHE II; Septic Severity Score, SSS), the intraabd ominal and systemic inflammatory response, and the translocation of ba cteria and endotoxin. RESULTS: The comparison of the 10 survivors with the nonsurviving group revealed no differences as :to the length of h istory, serum lactate levels, white blood cell counts, body temperatur e, markers of the inflammatory response, or quantity and macroscopic q uality of the exudate. Differences were found in intraperitoneal bacte riology (prevalence 0.37, negative predictive value for lethal outcome 0.8), endotoxin concentrations in the exudate (P = 0.02) and in the p lasma (P = 0.015), fibrinopeptide A levels (exudate P = 0.036; plasma P = 0.015), PGE(2) plasma concentration (P = 0.0357), and APACHE II (P = 0.0034) and SSS (P = 0.0027) values. CONCLUSION: The clinical cours e of ischemic bowel wall necrosis seems to depend on the severity of t he disease at admission and on the integrity of the mucosal barrier ra ther than on inflammatory response, therapeutic measures, or supportiv e treatment. (C) 1997 by Excerpta Medica, Inc.