October 1970

Intestinal Mucosal Lesion in Low-Flow StatesI. A Morphological, Hemodynamic, and Metabolic Reappraisal

Author Affiliations

From the McGill University Surgical Clinic, Montreal General Hospital, Montreal.

Arch Surg. 1970;101(4):478-483. doi:10.1001/archsurg.1970.01340280030009

Sequential studies of the intestinal mucosal lesion in low-flow states revealed that the extent of the damage is dependent upon flow. Microscopic evidence of epithelial disruption at the subnuclear portion and subsequent lifting off of the epithelial layer is presented and correlated with the postulated metabolic transport barrier at the epithelial-capillary interface. The formation of such a barrier may be related to the peculiar anatomico-physiological arrangements of the intestinal villi and may deprive the epithelial cells of important substrates during and after a period of hypoperfusion. The concept of intestinal mucosal necrobiosis is reappraised in the light of such findings, and an explanation is presented for certain paradoxes observed in the bioenergetic studies as well as for the high susceptibility of the intestinal mucosa to damage in the low-flow states.