INTESTINAL PERMEABILITY IS INCREASED AFTER MAJOR VASCULAR-SURGERY

Purpose. In experimental animals increased intestinal permeability has been demonstrated after ischemia and reperfusion injury. In this study we determined intestinal permeability in patients after elective or emergency aortic aneurysm repair; the latter patients were in severe shock on hospital admission. Methods: A dual sugar absorption test, with lactulose and mannitol as markers, was used to measure intestinal permeability on the second day between 24 and 30 hours after hospital admission. Results. The lactulose/mannitol excretion ration was 0.012 +/- 0.005 in seven healthy control subjects, 0.118 +/- 0.116 in seven patients having elective operation, and 0.098 +/- 0.093 in eight patients having emergency operation, indicating a significant increase of intestinal permeability in both patient groups (p < 0.01). No significant difference was found in intestinal permeability between patients of the elective and emergency groups. Conclusions. A significant increase in intestinal permeability commonly occurs in patients after elective and emergency major vascular surgery. It is suggested that this is mainly due to reperfusion injury rather than the ischemic period of the intestine itself.