Obstrucción intestinal en pacientes con apendicitis / Intestinal obstruction in appendicitis

Introducción: La apendicitis aguda como causa de obstrucción intestinal es una situación clínica infrecuente. Los objetivos de este estudio son los de definir la incidencia de obstrucción intestinal de acuerdo con la clasificación de obstrucción intestinal en apendicitis y la caracterización de su severidad. Métodos: Se diseñó un estudio de cohorte retrospectiva analizando todos los pacientes operados por obstrucción intestinal secundaria a apendicitis durante un periodo de 15 años. Se incluyeron variables continuas y categóricas tales como edad, sexo, periodo de tiempo entre el inicio de los síntomas y el diagnóstico, valores de proteína C reactiva, recuento de leucocitos, tipo de obstrucción intestinal y la puntuación del WSES Sepsis Severity Score. Resultados: Durante el periodo de estudio, un total de 3.626 pacientes fueron operados por apendicitis; en 44 casos se encontró una obstrucción intestinal asociada (1,2%). De acuerdo con la clasificación de obstrucción intestinal en apendicitis, la mayoría de estos pacientes presentaron un íleo mecánico con estrangulación del intestino (48%). La mayor parte de los pacientes (77%) presentaron una puntuación de 3 puntos o menos en el WSES Sepsis Severity Score. Conclusiones: La incidencia de obstrucción intestinal en apendicitis fue mayor de lo esperado. Estos pacientes presentaron una respuesta inflamatoria severa, con una puntuación en el WSES Sepsis Severity Score de 3 puntos. De acuerdo con la clasificación de obstrucción intestinal, la mayoría de los casos presentaron obstrucción mecánica con estrangulación.

Introduction: Appendicitis as a cause of intestinal obstruction is an infrequent condition. The purpose of this study was to define the incidence of intestinal obstruction according to the classification of intestinal obstruction secondary to appendicitis, and to characterize their severity. Methods: A retrospective cohort study analyzing all patients operated on for intestinal obstruction secondary to appendicitis within a 15 year period was designed. Continuous and categorical variables including: age, gender, time interval between onset of symptoms and diagnosis, C-reactive protein and white blood cells values, type of intestinal obstruction and WSES Sepsis Severity Score, were included. Results: During the period of study, 3,626 patients were operated on for appendicitis and 44 cases had associated intestinal obstruction (1.2%). According to the classification of intestinal obstruction in appendicitis, most patients had a mechanical ileus with strangulation (48%). Most patients had a WSES Sepsis Severity Score of 3 or less points (77%). Conclusions: The incidence of intestinal obstruction in appendicitis was higher than expected. These patients had a severe inflammatory response with a WSES Sepsis Severity Score of 3 points. According to the classification of intestinal obstruction in appendicitis, most patients had a mechanical obstruction with strangulation.

Mesenteric microcirculatory dysfunctions and translocation of indigenous bacteria in a rat model of strangulated small bowel obstruction

PRUPOSE: Bacterial translocation has been shown to occur in critically ill patients after extensive trauma, shock, sepsis, or thermal injury. The present study investigates mesenteric microcirculatory dysfunctions, the bacterial translocation phenomenon, and hemodynamic/metabolic disturbances in a rat model of intestinal obstruction and ischemia. METHODS: Anesthetized (pentobarbital 50 mg/kg, i.p.) male Wistar rats (250-350 g) were submitted to intestinal obstruction or laparotomy without intestinal obstruction (Sham) and were evaluated 24 hours later. Bacterial translocation was assessed by bacterial culture of the mesenteric lymph nodes (MLN), liver, spleen, and blood. Leukocyte-endothelial interactions in the mesenteric microcirculation were assessed by intravital microscopy, and P-selectin and intercellular adhesion molecule (ICAM)-1 expressions were quantified by immunohistochemistry. Hematocrit, blood gases, lactate, glucose, white blood cells, serum urea, creatinine, bilirubin, and hepatic enzymes were measured. RESULTS: About 86 percent of intestinal obstruction rats presented positive cultures for E. coli in samples of the mesenteric lymph nodes, liver, and spleen, and 57 percent had positive hemocultures. In comparison to the Sham rats, intestinal obstruction induced neutrophilia and increased the number of rolling (~2-fold), adherent (~5-fold), and migrated leukocytes (~11-fold); this increase was accompanied by an increased expression of P-selectin (~2-fold) and intercellular adhesion molecule-1 (~2-fold) in the mesenteric microcirculation. Intestinal obstruction rats exhibited decreased PaCO2, alkalosis, hyperlactatemia, and hyperglycemia, and increased blood potassium, hepatic enzyme activity, serum urea, creatinine, and bilirubin. A high mortality rate was observed after intestinal obstruction (83 percent at 72 h vs. 0 percent in Sham rats). CONCLUSION: Intestinal obstruction and ischemia in rats is a relevant model for ...