[A case of intestinal obstruction].
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A hyperosmolal glucose solution was introduced into a loop of small intestine of specified length and position while intravenous infusions of varying osmolality were given at the same time. The hyperosmolal solution in the lumen caused damage primarily to the tips of the villi where sloughing of the epithelial cells was frequently seen. These defects were repaired by an increase in surface coverage by neighboring epithelial cells, which thus were reduced in height. A varying degree of edema was generally seen in the epithelial cells. The severity of these lesions was modified by intravenous infusions in inverse relationship to the osmolality of the infusions. Thus the defence mounted by the intestinal mucosa against the hyperosmolal solution in the lumen was impaired by the infusion of hypo-osmolal solutions and improved by hyperosmolal solutions. In the latter cases the mucosa maintained a practically normal histological picture.
We investigated the effects of autonomic drugs and the role of intestinal contents on the motility changes that occur during acute obstruction. Myoelectric activity was recorded from seven electrodes spaced at 3-cm intervals along the midjejunum of nine conscious dogs. Another animal had electrodes evenly placed throughout the small bowel. Obstruction was created by inflation of an intraluminal balloon. Systemic arterial blood pressure and pulse rate were monitored. Initially, motor activity of the small intestine increased proximal to an acute intestinal obstruction and decreased distally. Recordings from the entire small intestine revealed that these effects occurred almost immediately in the region of the obstruction but not at more distant sites. Within 2-3 h, however, proximal hypermotility had extended to the duodenum and distal inhibition had progressed to the terminal ileum. Diversion of intestinal contents without obstruction reduced myoelectric activity distal to the site of drainage. However, reinfusion of chyme distal to the site of obstruction failed to restore inhibited motor activity to control levels. Atropine sulfate (50 micrograms/kg) decreased and neostigmine (5 micrograms X kg-1 X min-1) potentiated the hyperactivity proximal to the obstruction, but neither agent significantly affected the distal inhibition. Phentolamine (1 mg/kg) and propranolol (1 mg/kg) had no effect on proximal or distal motor activity during obstruction; these were doses that blocked cardiovascular responses to adrenergic agonists. These results suggest that changes in luminal contents and in nervous activity both contribute to the intestinal motility changes that accompany obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)
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