Osificación heterotópica mesentérica como causa de obstrucción intestinal en un paciente con abdomen séptico / Mesenteric Heterotopic Ossification as a Cause of Intestinal Obstruction in a Patient with a Septic Abdomen

Presentación del caso. Se trata de un masculino de 49 años, con historia de un trauma abdominal cerrado con un objeto contuso sin alteraciones hemodinámicas. La ecografía focalizada de traumatismos resultó positiva a líquido libre en la cavidad abdominal en tres ventanas. Intervención terapéutica. Fue sometido a múltiples laparotomías exploratorias con lavados de cavidad abdominal posterior a presentar un cuadro de abdomen séptico Björk 4, quien después de 38 días de estancia intrahospitalaria presentó una fístula enteroatmosférica que causaba un déficit nutricional. En una intervención quirúrgica se realizó el cierre de la fístula enteroatmosférica, con el hallazgo de tejido óseo trabecular en cavidad abdominal, correspondiente a osificación heterotópica intraabdominal de formación reciente. Evolución clínica. Luego de la anastomosis del intestino delgado presentó signos de obstrucción intestinal, a causa de esto, se realizó una nueva laparotomía exploratoria, en la que se encontró tejido óseo adherido al mesenterio del intestino delgado que generó una obstrucción completa, se extirpó el material óseo y se logra restablecer el flujo intestinal liberando la obstrucción en el intestino delgado

Case presentation. A 49-year-old male, with a history of blunt abdominal trauma with a blunt object without hemodynamic alterations. The focused trauma ultrasound was positive for free fluid in the abdominal cavity in three windows. Treatment.The patient underwent multiple exploratory laparotomies with peritoneal lavage after presenting a septic abdomen (Björk 4), who after 38 days of intrahospital stay presented an enteroatmospheric fistula that caused a large nutritional deficit. In a surgical intervention, the enteroatmospheric fistula was closed, with the finding of trabecular bone tissue in the abdominal cavity, corresponding to intra-abdominal heterotopic ossification of recent formation. Outcome. After the small intestine anastomosis, he presented signs of intestinal obstruction, because of this, a new exploratory laparotomy was performed, in which bone tissue was found adhered to the mesentery of the small intestine that generated a complete obstruction. The bone material was removed and the intestinal flow was reestablished, freeing the obstruction in the small intestine

Study on Mechanism of Taoren Chengqitang in Regulating Intestinal Myoelectrical Activity and Microenvironment Homeostasis in Intestinal Sepsis Rats Based on HMGB1/TLR4/NF-κB Pathway / 中国实验方剂学杂志

Objective:To study the mechanism of Taoren Chengqitang in regulating intestinal myoelectric activity and microenvironment homeostasis in intestinal sepsis rats based on high mobility group protein 1(HMGB1)/Toll-like receptor 4(TLR4)/nuclear factor -κB(NF-κB) pathway. Method:The 60 SD rats were randomly divided into sham operation group, model group, glycyrrhizic acid (HMGB1 inhibitor, 0.03 g·kg-1) group, Taoren Chengqitang group (10 g·kg-1), glycyrrhizic acid+Taoren Chengqitang group (0.03 g·kg-1+10 g·kg-1), with 12 rats in each group. Except the sham operation group, the other groups established intestinal sepsis rat models, each group was treated with medicine, hematoxylin-eosin (HE) staining was used to detect the histopathological changes of small intestinal mucosa in rats of each group, the changes of mucosal thickness and villus height were compared, the levels of secretory immunoglobulin A (sIgA), diamine oxidase (DAO) and D-lactic acid in intestinal mucosa of rats were detected by kit, the intestinal myoelectrical activity of rats in each group was measured, the slow wave frequency and amplitude of small intestinal smooth muscle were compared, the intestinal flora of rats in each group was detected, the contents of E. coli, Bifidobacterium and Lactobacillus were compared, and the expressions of HMGB1/TLR4/NF-κB pathway proteins HMGB1, TLR4, MyD88 and NF-κB p65 in small intestinal tissues were detected by Western blot. Result:Compared with sham operated group, the villus height, mucosal thickness, sIgA content, slow wave frequency and amplitude of smooth muscle, Bifidobacterium and Lactobacillus contents in intestinal mucosa of model group rats were significantly decreased, and serum DAO and D-lactic acid levels, intestinal E. coli content, intestinal tissue HMGB1, TLR4, MyD88 and NF-κB p65 proteins were significantly increased (P<0.05). Compared with the model group, the villus height, mucosal thickness, sIgA content, slow wave frequency and amplitude of smooth muscle, Bifidobacterium and Lactobacillus contents in intestinal mucosa of the Taoren Chengqitang group, glycyrrhizic acid group, and glycyrrhizic acid + Taoren Chengqitang group were significantly increased, and serum DAO and D-lactic acid levels, intestinal E. coli content, intestinal tissue HMGB1, TLR4, MyD88 and NF-κB p65 proteins were significantly decreased (P<0.05). Compared with the Taoren Chengqitang group and the glycyrrhizic acid group, the villus height, mucosal thickness, sIgA content, slow wave frequency and amplitude of smooth muscle, Bifidobacterium and Lactobacillus contents in intestinal mucosa of glycyrrhizic acid+Taoren Chengqitang group were significantly increased, and serum DAO and D-lactic acid levels, intestinal E. coli content, intestinal tissue HMGB1, TLR4, MyD88 and NF-κB p65 proteins were significantly decreased, the differences were statistically significant (P<0.05). Conclusions:Taoren Chengqitang can alleviate intestinal mucosal injury, regulate intestinal myoelectrical activity and microenvironment homeostasis, restore intestinal function and maintain flora balance in intestinal sepsis rats, which may be achieved by down-regulating HMGB1/TLR4/NF-κB pathway.

Effects of antibiotics on intestinal microflora and intestinal mucosal barrier function and its mechanisms / 中华危重病急救医学

Antibiotics are the cornerstone to cure infectious diseases, however, it also destroys the intestinal inherent microflora, and may cause serious gastrointestinal dysfunction, such as abdominal distension, diarrhea, mucosal barrier damage etc. In severe conditions, it may induce intestinal sepsis. With the development of the human microbiology group program and the popularity of microbial sequencing technology, people can comprehend the effects of antibiotics on intestinal flora deeply, meanwhile the traditional biomedical model (the basis of bacterial disease) is questioned. It presents the effects and mechanisms of antibiotics on intestinal microflora and intestinal mucosal barrier function in detail and demonstrates the feasibility by the treatment of probiotics and fecal transplantation to construct "health-promoting microbes" to adjust gastrointestinal function, in addition, it can promote the rational use of antibiotics.