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Effects of luminal distension and obstruction on the intestinal circulation

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Abstract

The effects of luminal distension and obstruction on intestinal blood flow and oxygen uptake have been studied in animal experiments. Distending pressures of 20 mmHg or less impair regional blood flow and augment oxygen uptake, but do not reduce the capillary area open to perfusion, whereas pressures in excess of this level cause concomitant decreases in blood flow, oxygen uptake and capillary perfusion.

However, the distension of obstruction, as opposed to artificial distension, only modestly increases intraluminal pressure and accordingly reduces, rather than augments, vascular resistance. This discrepancy invalidates artificial distension as a model for studying the hemodynamic effects of intestinal obstruction. The difference in the hemodynamic effects may be caused by different rates of stretch; a rapid artificial distension augments vascular resistance, whereas the slow distension of obstruction does not, since the distensibility of the gut wall is greatly enhanced.

Although simple obstruction per se does not threaten the bowel's microcirculation or its viability, obstruction renders the gut wall vulnerable to further distension. Thus, a moderate additional distension virtually abolishes the perfused capillary surface area. An intervening decompression seems to restore the capacity of the capillary bed to withstand renewed distension.

Some cautious clinical inferences are drawn from these animal experiments: an intraoperative decompression of obstructed intestine, although causing some degree of gut wall edema and a slight augmentation of vascular resistance, might enable microcirculation to withstand renewed distension of the intestine.

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  1. Department of Surgery, Karolinska Hospital, S-104 01, Stockholm, Sweden

    Ulf Öhman & Henrik Ehrén

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  1. Ulf Öhman
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  2. Henrik Ehrén
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Öhman, U., Ehrén, H. Effects of luminal distension and obstruction on the intestinal circulation. Pediatr Surg Int 1, 4–9 (1986). https://doi.org/10.1007/BF00171774

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