Francisco Edilson Leite Pinto Júnior

Bacterial translocation in rats nonfunctioning diverted distal colon

PURPOSE To investigate whether the alterations of the diverted colon segment mucosa, evidenced in fecal colitis, would be able to alter Bacterial Translocation (BT). METHODS Sixty-two Wistar male rats ranging from 220 to 320 grams of weight, were divided in two groups: A (Colostomy) and B (Control), with 31 animals each one. In group A, all animals underwent end colostomy, one stoma, in ascending colon; and in the 70th POD was injected in five rats, by rectal route diverted segment - 2 ml of a 0.9% saline solution in animals (A1 subgroup); in eight it was inoculated, by rectal route, 2 ml of a solution containing Escherichia coli ATCC 25922 (American Type Culture Collection), in a concentration of 10(8) Colony Forming Unit for milliliters (CFU/ml) - A2 Subgroup; in ten animals the same solution of E. coli was inoculated, in a concentration of 10(11) CFU/ml (A3 Subgroup); and in eight it was collected part of the mucus found in the diverted distal colonic segment for neutral sugars and total proteins dosage (A4 subgroup). The animals from the group B underwent the same procedures of group A, but with differences in the colostomy confection. In rats from subgroups A1, A2, A3, B1, B2, and B3 2 ml of blood were aspirated from the heart, and fragments from mesenteric lymphatic nodule, liver, spleen, lung and kidney taken for microbiological analysis, after their death. This analysis consisted of evidencing the presence of E. coli ATCC 25922 CFU. Mann-Whitney and ANOVA Tests were applied as analytic techniques for association of variables. RESULTS The occurrence of BT was evidenced only in those animals in which inoculated concentration of E. coli ATCC 25922, reached levels of 10(11)CFU/ml, i.e. in Subgroups A3 and B3, although, being significantly greater (80%) in those animals without colostomy (subgroup B3) when compared to the ones with colostomy (20%) from the subgroup A3 (P <0.05). Lung, liver and mesenteric lymphatic nodules were the tissues with larger percentile of bacterial recovery, so much in subgroup A3, as in B3. Blood culture was considered positive in 60% of the animals from subgroup B3 and in 10% of those from subgroup A3 (p <0.05). There was greater concentration of neutral sugars, in subgroup A4 - mean 27.3mg/ml -, than in subgroup B4 - mean 8.4 mg/ml - (P <0.05). CONCLUSION The modifications in the architecture of intestinal mucosa in colitis following fecal diversion can cause alterations in the intestinal barrier, but it does not necessarily lead to an increased frequency of BT.

Comparison of prophylactic and therapeutic use of short-chain fatty acid enemas in diversion colitis: a study in Wistar rats

OBJECTIVES: To study the effect of short‐chain fatty‐acids on atrophy and inflammation of excluded colonic segments before and after the development of diversion colitis. INTRODUCTION: Diversion colitis is a chronic inflammatory process affecting the dysfunctional colon, possibly evolving with mucous and blood discharge. The most favored hypotheses to explain its development is short‐chain fatty‐acid deficiency in the colon lumen. METHODS: Wistar rats were submitted to colostomy with distal colon exclusion. Two control groups (A1 and B1) received rectally administered physiological saline, whereas two experimental groups (A2 and B2) received rectally administered short‐chain fatty‐acids. The A groups were prophylactically treated (5th to 40th days postoperatively), whereas the B groups were therapeutically treated (after post‐operative day 40). The mucosal thickness of the excluded colon was measured histologically. The inflammatory reaction of the mucosal lamina propria and the lymphoid tissue response were quantified through established scores. RESULTS: There was a significant thickness recovery of the colonic mucosa in group B2 animals (p  =  0.0001), which also exhibited a significant reduction in the number of eosinophilic polymorphonuclear cells in the lamina propria (p  =  0.0126) and in the intestinal lumen (p  =  0.0256). Group A2 showed no mucosal thickness recovery and significant increases in the numbers of lymphocytes (p  =  0.0006) and eosinophilic polymorphonuclear cells in the lamina propria of the mucosa (p  =  0.0022). CONCLUSION: Therapeutic use of short‐chain fatty‐acids significantly reduced eosinophilic polymorphonuclear cell numbers in the intestinal wall and in the colonic lumen; it also reversed the atrophy of the colonic mucosa. Prophylactic use did not impede the development of mucosal atrophy.

Neoplasia papilar cística do pâncreas

Papyllary cystic tumor of the pancreas, so-called Frantzs tumor, is rare. Clinical presentation of this disease is usually a slowly growing abdominal mass with or without abdominal pain, affecting predominantly young females. Its pathogenesis is still unknown . Surgical resection is usually curative, and prognosis is excellent. The authors report two pancreatic tumor cases(Frantzs tumor) in women aged 26 and 31 years old. Pre operative assessment showed a solid-cystic tumor of the tail and body of the pancreas. An extended distal pancreatectomy was performed without splenic preservation.

Colite de derivação fecal

The authors present a revision of diversion colitis. It is an inflammatory disorder that occurs in the colorectum segment after a diverting colostomy. The main features of this disease are: colon or rectum disfunction; no previous intestinal inflammatory disorder; it never attacks the colon upper colostomy; after intestinal transit restoration, the inflammatory process is solved. Many hypothesis are postulated to explain its occurrance. They include: fecal stasis; changes in the bacterial population of colon; nutritional deficiency of colonic epithelium due to the absence of short chain fatty acids in the defunctionalized segment is the most accepted nowadays. The absence of fatty acids produces energetic defficiency in colon mucosa, reduced electrolite absorption and secretion, and reduced mucus production. The patients have abdominal pain, mucus diarrhoea and bleeding. Histopathological features include chronical inflamation of colon wall, vascular congestion and changes in mucosa cripts. Lynphoid hiperplasy of mucosa and submucosa are common. The diagnosis is done by endoscopy, radiology, pathology and laboratory data. Surgery is considered the best treatment and when the intestinal continuity is restored the patients get cured. The topical use of short chain fatty acids by enema have had good results in some cases. As diversion colitis results in many assimptomatic patients, its incidence is understimated and more attention is needed always when a colostomy is done.

Perfuração espontânea de colédoco em adolescente

Spontaneous perforation of the common bile duct is rare. It happens predominantly in children and it is related to obstructive disease of the biliary tract. We present a case of an 18 year-old male patient, with ulcerative rectocolitis associated with malignant tumor of the head of pancreas. The patient developed an acute abdomen syndrome and laparotomy, a spontaneous perforation of common bile duct was evidenced. The authors make a revision of the clinical aspects of that pathology.