Radiation induced small bowel "web" formation is associated with acquired microvascular dysfunction

Hatoum, O. A.; Binion, D. G.; Phillips, S. A.; O'Loughlin, C.; Komorowski, R. A.; Gutterman, D. D.; Otterson, M. F.
December 2005
Gut;Dec2005, Vol. 54 Issue 12, p1797
Academic Journal
Background and aims: Radiation therapy of abdominal and pelvic solid tumours results in late intestinal toxicity of a severe nature in approximately 5% of cases. These manifestations may include ischaemia and stricture formation, which may present as "webs". These webs are likely to play a rote in the pathogenesis of recurrent bowel obstruction. The mechanisms of microvascular injury to the bowel in the setting of radiation have not been defined. We hypothesised that microvascular dysfunction with impaired vasodilation to acelytcholine (Ach) would be an acquired pathophysiological abnormality in radiation and "web" formation. Methods: A 40 year old patient treated with radiation, two years previously, for an anal squamous cell cancer presented with recurrent small bowel obstruction. "Webs" in the distal ileum were detected using wireless capsule endoscopy, after small bowel barium radiographs failed to demonstrate a lesion. Following resection, freshly isolated 50-150 μm diameter arterioles from the "web" and adjacent normal calibre bowel were analysed with histology and microvessel physiological studies. Results: After constriction (30-50%) with endothelin, dilation to graded doses of Ach (10-9-10-4 M) was observed in vessels dissected from the stricture and the adjacent normal calibre area. Ach dilation was reduced in vessels from "web" (mean diameter 7 (2)%; n =3, p<0.01) compared with the adjacent unaffected bowel (mean diameter 85 (5)%). Dihydroethidine and dichlorofluorescein diacetate intravital staining demonstrated increased reactive oxygen species production in microvessels from "web" compared with adjacent normal calibre bowel. Histology from the strictured bowel demonstrated narrowing of the arterial lumen due to intimal and muscularis propria fibrosis, with endothelial preservation. Conclusions: External radiation is associated with acquired microvascular endothelial dysfunction and "web" formation in the small bowel.


Related Articles

  • Changes in Cardiac Autonomic Activities in Patients with Syndrome X A Study of Spectral Analysis of Heart Rate Variability. Lee, Wen Lieng; Chen, Jaw-Wen; Kong, Chi Woon; Wang, Jiann Jong; Ting, Chih-Tai; Chan, Wan Leong; Wang, Shih-Pu; Chang, Mau-Song // Angiology;Oct1996, Vol. 47 Issue 10, p929 

    The present study was designed to assess cardiac autonomic activities, coronary microvascular function, and their relationship in patients with syndrome X. Control of coronary blood flow is complex, and impaired coronary flow reserve has been attributed as the cause of myocardial ischemia in...

  • Small Intestine Ischaemia due to Volvulus during Pregnancy. NAMEIRAKPAM, SHANTAJIT; KEISHING, SHANGCHUNGLA; LAISHRAM, JLALESHWAR; DEVI, S. RANITA // Journal of Clinical & Diagnostic Research;Apr2014, Vol. 8 Issue 4, p1 

    Small intestine ischaemia caused by volvulus is difficult to diagnose during pregnancy, as the signs and symptoms may be masked by pregnancy. An early diagnosis and a prompt surgical intervention is necessary, as morbidity and mortality of this disorder are significant. We are presenting a case...

  • Beneficial Effects of Intracoronary Nicorandil on Microvascular Dysfunction After Primary Percutaneous Coronary Intervention: Demonstration of Its Superiority to Nitroglycerin in a Cross-Over Study. Ito, Noritoshi; Nanto, Shinsuke; Doi, Yasuji; Kurozumi, Yuma; Natsukawa, Tomoaki; Shibata, Hiroyuki; Morita, Masaya; Kawata, Atsushi; Tsuruoka, Ayumu; Sawano, Hirotaka; Okada, Ken-ichiro; Sakata, Yasuhiko; Kai, Tatsuro; Hayashi, Toru // Cardiovascular Drugs & Therapy;Aug2013, Vol. 27 Issue 4, p279 

    Purpose: In patients undergoing primary percutaneous coronary intervention (PCI) for the treatment of ST-segment elevation myocardial infarction (STEMI), coronary microvascular dysfunction is associated with poor prognosis. Coronary microvascular resistance is predominantly regulated by...

  • Ischemic preconditioning attenuates capillary no-reflow and leukocyte adherence in postischemic pancreatitis. Obermaier, R.; von Dobschuetz, E.; Drognitz, O.; Hopt, U.; Benz, S. // Langenbeck's Archives of Surgery;Dec2004, Vol. 389 Issue 6, p511 

    Background and aims: Ischemic preconditioning (IPC) has been shown to protect several organs from ischemia-reperfusion injury. Postischemic microvascular dysfunction is considered to be the key mechanism of early graft pancreatitis after transplantation. The aim of the study was to determine...

  • FECAL IMPACTION AS A CAUSE OF ACUTE LOWER LIMB ISCHEMIA. Hoballah, J. J.; Chalmers, R. T. A.; Sharp, W. J.; Corson, J. D.; Stokes, J. B. // American Journal of Gastroenterology;Nov1995, Vol. 90 Issue 11, p2055 

    Acute lower extremity ischemin secondary, to fecal impaction has not been previously reported. Herein, we report the case of an elderly man who was referred to our medical center with an acutely ischemic right lower extremity and a possible abdominal aortic aneurysm. The suspicious abdominal...

  • Transhiatal oesophagectomy: A simple technique to carry out gastric or colonic conduit pull-up. Goh, A. H.; Park, K. G. M. // Surgeon (Edinburgh University Press);Feb2007, Vol. 5 Issue 1, p51 

    Following translatai oesophagectomy, delivery of the conduit into the posterior mediastinum and neck can potentially result in its devascularisation. A simple technique is described to protect the conduit during this phase of the operation. This procedure has now been performed in 56 consecutive...

  • The microvasculature of the human cerebellar meninges. Nonaka, Hiroko; Akima, Michiko; Hatori, Tsutomu; Nagayama, Tadashi; Zhang, Zean; Ihara, Fumie // Acta Neuropathologica;Dec2002, Vol. 104 Issue 6, p608 

    The vascular architecture of the human cerebellar meninges was investigated. The surface meninges were poor in vasculature. In the sulci, the meninges were highly vascular but had few capillaries. The venous blood vessels gave long side branches at right angles to the parent vessels in a...

  • Effect of Slow Coronary Flow on P-Wave Duration and Dispersion. Turkmen, Muhsin; Barutcu, Irfan; Esen, Ali Metin; Karakaya, Osman; Esen, Oziem; Basaran, Yelda // Angiology;Aug/Sep2007, Vol. 58 Issue 4, p408 

    The slow coronary flow (SCF) phenomenon is often considered to be an incidental angiographic finding; however, several reports have shown it to be associated with cardiac events. In this study we aimed to assess P-wave duration and dispersion (PWD) in patients with SCF and to compare it with...

  • VASCULAR CHANGES OF THE HAND IN PROFESSIONAL BASEBALL PLAYERS WITH EMPHASIS ON DIGITAL ISCHEMIA IN CATCHERS. Ginn, T. Adam; Smith, Adam M.; Snyder, Jon R.; Koman, L. Andrew; Smith, Beth P.; Rushing, Julia // Journal of Bone & Joint Surgery, American Volume;Jul2005, Vol. 87-A Issue 7, p1464 

    Background: Repetitive trauma to the hand is a concern for baseball players. The present study investigated the effects of repetitive trauma and the prevalence of microvascular pathological changes in the hands of minor league professional baseball players. In contrast to previous investigators,...


Read the Article


Sign out of this library

Other Topics