World Journal of Surgery

, Volume 9, Issue 6, pp 825–832 | Cite as

Postoperative adaptation of the small intestine

  • James B. Bristol
  • Robin C. N. Williamson

Abstract

For nearly 100 years, the small intestine has been known to compensate for partial tissue loss. For only some 20 years has the phenomenon been studied in any depth, and a small proportion of these investigations has been undertaken in humans. Experimental and clinical data show that enteric mucosal hyperplasia in the remaining small bowel after enteric resection or bypass is accompanied by cytokinetic and functional adaptation. In general, the degree of adaptation depends on 3 factors: the amount of tissue excised or excluded, the particular enteric segment involved, and the presence or absence of a normal luminal stream. Thus, massive enterectomy can overwhelm the adaptive capacity of the gut, loss of jejunum is better tolerated than loss of terminal ileum, and total parenteral nutrition will abolish the compensatory response. The mechanisms that govern adaptive change are complex and interrelated. They involve both luminal agents (food, alimentary secretions) and humoral influences, of which enteroglucagon appears to be the most important. Wherever possible, small bowel operations should take account of adaptive phenomena in order to minimize metabolic and nutritional sequelae.

Résumé

Depuis près de 100 ans on sait que l'intestin grÊle est capable de compenser les conséquences d'une perte partielle de tissu intestinal mais c'est seulement depuis une vingtaine d'années que le phénomène a été étudié sérieusement expérimentalement et dans une moindre mesure chez l'homme. Les données ainsi obtenues ont montré que l'hyperplasie de la muqueuse intestinale dans l'intestin restant après résection ou court-circuit intestinal allait de pair avec son adaptation fonctionnelle et cytocinétique. En général, le degré d'adaptation dépend de trois facteurs: la longueur d'intestin exclu, le segment de grÊle interessé, la présence ou l'absence de passage du bol intestinal. Ainsi l'entérectomie massive dépasse la capacité d'adaptation de l'intestin, la jéjunectomie est mieux tolérée que l'entérectomie distale et l'alimentation parentérale totale est susceptible de supprimer le mécanisme d'adaptation. Ce mécanisme est complexe et dépend de nombreux éléments qui incluent des facteurs intestinaux propres: nature des aliments et sécrétions du tractus alimentaire ainsi que des facteurs humoraux parmi lesquels l'entéroglucagon occupe la place la plus importante. Dans la mesure du possible les interventions sur l'intestin grÊle doivent prendre en compte ce phénomène d'adaptation de manière à réduire les séquelles nutritionnelles et métaboliques.

Resumen

Desde hace casi ya 100 años se conoce como el intestino delgado es capaz de desarrollar cambios compensatorios frente a pérdida de sus tejidos. Pero es sólo en los Últimos 20 años que el fenómeno ha sido estudiado en profundidad, y apenas una proporción pequeña de las investigaciones ha sido realizada en el ser humano. Estudios experimentales y clínicos muestran que la hiperplasia de la mucosa que se observa en el intestino residual después de la resección o de derivación entérica se acompaña de adaptación citoquinética y funcional. En general el grado de adaptación depende de tres factores: la magnitud del tejido resecado o excluido, el segmento particular de intestino involucrado y la presencia o ausencia de flujo intraluminal. Es así como una enterectomía masiva puede apabullar la capacidad de adaptación del intestino, la pérdida de yeyuno es mejor tolerada que la pérdida de ileon terminal y la nutrición parenteral total anula la respuesta compensatoria. Los mecanismos que gobiernan el fenómeno de adaptación son complejos y aparecen interrelacionados. Ellos incluyen tanto agentes intraluminales (alimentos, secreciones digestivas) como sustancias humorales, entre las cuales el enteroglucagón parece ser la de mayor importancia. En cuanto sea posible, las operaciones sobre el intestino delgado deben ser realizadas teniendo en cuenta estos fenómenos de adaptación, en tal forma que las secuelas metabólicas y nutricionales queden reducidas al mínimo.

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Copyright information

© Société Internationale de Chirurgie 1985

Authors and Affiliations

  • James B. Bristol
    • 1
  • Robin C. N. Williamson
    • 1
  1. 1.University Department of SurgeryBristol Royal InfirmaryBristolUK

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