Ethacrynic acid decreases expression of proinflammatory intestinal wall cytokines and ameliorates gastrointestinal stasis in murine postoperative ileus

OBJECTIVES: Several compounds characterized by an olefin linkage conjugated to a carbonyl group have anti-inflammatory properties. The diuretic ethacrynic acid (EA) is a compound of this type. Herein, we tested the hypothesis that ethacrynic acid can modulate the development of ileus after bowel manipulation. METHODS: Groups (n=9) of male C57Bl/6 mice underwent surgical manipulation of the small intestine using a pair of cotton-tipped applicators (MAN). Control animals (CONT) did not undergo any surgical intervention or receive treatment. MAN mice were pre- and post-treated with four intraperitoneal doses of phosphate buffered saline (PBS), EA1 (1mg/kg per dose), or EA10 (10mg/kg per dose). Gastrointestinal transit of non-absorbable FITC-labeled dextran was assessed by gavaging the mice with the tracer 24h after operation and assessing FD70 concentration 120 min later in the bowel contents from the stomach, 10 equally long segments of small intestine, cecum, and two equally long segments of colon. The geometric center for the tracer was calculated for each animal. Expression of interleukin-6 (IL-6) and inducible nitric oxide synthase (iNOS) transcripts in the ileal muscularis propria was assessed using semiquantitative reverse transcriptase-polymerase chain reaction. RESULTS: In control animals, the mean (±SE) geometric center for the transit marker was 9.89±0.47, whereas it was 4.59±0.59 for PBS-treated animals (p<0.05 vs CONT). The geometric center for pre- post treatment with low (1mg/kg) and high (10mg/kg) doses of ethacrynic acid were 7.23±0.97 and 5.15±0.57, respectively. Compared to PBS, treatment with ethacrynic acid (1mg/kg) significantly decreased manipulation-induced IL-6 and iNOS mRNA expression in the wall of the small bowel. CONCLUSIONS: Pre- and post-treatment with ethacrynic acid ameliorates ileus and modulates inflammation in the gut wall induced by bowel manipulation.

Íleo biliar: reporte de dos casos / Gallstone Ileus: report of two cases

El íleo biliar es una patología poco común y de difícil diagnóstico prequirúgico, pues en la mayoría de los casos se presenta como obstrucción intestinal sin síntomas biliares asociados. En el artículo se presentan dos casos del 2010, cada uno con características diferentes respecto a la localización de la fístula y la evolución postoperatoria: una fístula colecistogástrica con obstrucción del íleon terminal y una fístula colecistoduodenal con obstrucción del yeyuno medio. En el primero se hizo una resolución del íleo biliar y en el mismo tiempo quirúrgico la colecistectomía y cierre de la fístula; mientras que en el otro se trató únicamente el cuadro obstructivo. Dado que en la literatura no existe una amplia revisión de esta situación clínica, no hay consenso en cuanto a la resolución de la patología biliar en el mismo tiempo quirúrgico. Por la evolución clínica de los pacientes tan diversa, se evaluó el problema...

Gallstone ileus is an uncommon pathology, difficultto diagnose on a pre-surgical way, mostly sometimespresents as intestinal obstruction withoutbiliary symptoms associated. In 2010, it presentedtwo cases, each one with different characteristicsregarding the fistula location and post-operativeevolution: cholecystogastric fistula and obstructionof the terminal ileus and cholecystoduodenalfistula and obstruction of the medial yeyunum.First was resolved with colecystectomy and fistulaclosure. The second was trated only by obstructionresolution. Since in literature there isn’t acomprehensive review of this type of pathology,there is not agreement in the management of thebiliary pathology at the same surgical time, andtaking in account the different evolution of ourtwo patients, is the reason that we were interestedin the evaluation of this problem...