Original Article
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2014; 20(47): 17905-17913
Published online Dec 21, 2014. doi: 10.3748/wjg.v20.i47.17905
Protective effects of terminal ileostomy against bacterial translocation in a rat model of intestinal ischemia/reperfusion injury
Zhi-Liang Lin, Wen-Kui Yu, Shan-Jun Tan, Kai-Peng Duan, Yi Dong, Xiao-Wu Bai, Lin Xu, Ning Li
Zhi-Liang Lin, Wen-Kui Yu, Shan-Jun Tan, Kai-Peng Duan, Yi Dong, Ning Li, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
Xiao-Wu Bai, Lin Xu, Research Institute of General Surgery, Nanjing School of Clinical Medicine of Second Military Medical University at Nanjing General Hospital of Nanjing Military Command of PLA, Nanjing 210002, Jiangsu Province, China
Author contributions: Lin ZL and Yu WK contributed equally to this work; Yu WK designed the study; Lin ZL, Tan SJ, Duan KP, Dong Y and Bai XW performed the majority of experiments; Lin ZL, Tan SJ, Duan KP and Xu L collected and analyzed the data; Lin ZL and Yu WK wrote the manuscript; Li N, Yu WK and Xu L reviewed the paper.
Supported by National Natural Science Foundation of China No. 81270884, the 12th Five-Year Plan major project of PLA No. AWS12J001, and Jiangsu Province’s Key Medical Talent Program of China No. RC2011128
Correspondence to: Ning Li, MD, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan Zhonglu, Nanjing 210002, Jiangsu Province, China. li_ningrigs@126.com
Telephone: +86-25-80860089 Fax: +86-25-80860089
Received: April 5, 2014
Revised: June 18, 2014
Accepted: July 15, 2014
Published online: December 21, 2014
Processing time: 259 Days and 19.3 Hours
Abstract

AIM: To investigate the effects of terminal ileostomy on bacterial translocation (BT) and systemic inflammation after intestinal ischemia/reperfusion (I/R) injury in rats.

METHODS: Thirty-two rats were assigned to either the sham-operated group, I/R group, I/R + resection and anastomosis group, or the I/R + ileostomy group. The superior mesenteric artery was occluded for 60 min. After 4 h, tissue samples were collected for analysis. BT was assessed by bacteriologic cultures, intestinal permeability and serum levels of endotoxin; systemic inflammation was assessed by serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10, as well as by the activity of myeloperoxidase (MPO) and by intestinal histopathology.

RESULTS: Intestinal I/R injury not only caused morphologic damage to ileal mucosa, but also induced BT, increased MPO activity and promoted the release of TNF-α, IL-6, and IL-10 in serum. BT and ileal mucosa injuries were significantly improved and levels of TNF-α and IL-6 in serum were decreased in the I/R + ileostomy group compared with the I/R + resection and anastomosis group.

CONCLUSION: Terminal ileostomy can prevent the detrimental effects of intestinal I/R injury on BT, intestinal tissue, and inflammation.

Keywords: Bacterial reflux; Bacterial translocation; Intestinal ischemia/reperfusion; Terminal ileostomy

Core tip: Few studies have evaluated the occurrence of bacterial cecoileal reflux. We performed ileostomy to block the route of bacterial cecoileal reflux after intestinal ischemia/reperfusion injury. Compared with resection and anastomosis, ileostomy could improve the bacterial translocation, ileal mucosal injuries and systemic inflammation. The results provide a theoretic basis for the choice of ileostomy and resection/anastomosis in clinical practice.