Endotoxemia associated with intussusception and its diagnostic and surgical interventions

Abstract

To determine if and when intussusception results in endotoxemia and to evaluate whether diagnostic and surgical interventions of intussusception aggravate endotoxemia, intussusception was created in seven pigs during general anesthesia (ileocolic n = 3, ileo-ileocolic n = 2, ileocolic with silicone ring as leadpoint n = 1, ileoileal with silicone ring n = 1). After a period of observation and before progression to bowel gangrene, a diagnostic ultrasound study with a saline enema was undertaken, followed by a laparotomy and resection of the intussusception with a primary bowel anastomosis. Serial blood samples were obtained before and at regular intervals after: (1) formation of the intussusception; (2) the enema; and (3) resection for endotoxin measurement by limulus amebocyte lysate assay. The mean level of endotoxin increased from a pre-intussusception value of 0.750 EU/ml (range: 0.215-1.281) to a post-intussusception maximum of 1.482 EU/ml (0.997-2.882, P = 0.009), peaking mostly at 2 h after the intussusception. The mean pre-saline-enema level was 1.547 EU/ml (0.869-2.677) while the post-enema level was 1.41 EU/ml (0.84-2.468, P = 0.655). The mean pre-resection level was 1.470 EU/ml (0.784-2.468) while the post-resection maximum was (2.130 EU/ml) (0.850-4.381, P = 0.09). It is concluded that: (1) even in the absence of bowel gangrene intussusception results in significant endotoxemia within 2 h of its formation; (2) gentle saline enemas are not associated with endotoxemia; and (3) surgical resection results in a further upward surge of endotoxemia. These findings provide a scientific basis for improved understanding and management of intussusception.