Abstract
Strangulation is associated with an increased risk of mortality and morbidity in patients with mechanical bowel obstruction. The accurate and early recognition of the presence of strangulation is important to allow safe nonoperative treatment. A number of studies have shown that there was no single and reliable test to detect or exclude the presence of strangulation. The aim of this study was to evaluate the role of serum hexosaminidase (Hex) levels in recognition of strangulation in an experimental model of closed loop small bowel obstruction. Forty-two Wistar albino rats were divided into four groups: I, control (n=5); II, sham laparotomy (n=5); III, simple obstruction (n=16); and IV, strangulation groups (n=16). Activity levels of total Hex and its fractions (Hex A and B) were assayed in serum samples obtained from rats after 3 and 8 hr. Samples of small bowel were also evaluated histologically. Histological evaluation of bowel sections obtained from the strangulation group after 8 hr, revealed transmural hemorrhagic infarction in all animals with a mean ± SD total Hex activity of 978.25 ± 150 nmol/hr/ml, which was significantly higher than that in the other groups (P<0.001). Although sections of bowel from the strangulation group after 3 hr showed severe ischemic injury, the activities of total Hex, Hex A, and Hex B were not different from those of the control, sham, and simple obstruction groups. Histological examination of these groups did not show any sign of ischemia. Total Hex, Hex A, and Hex B activities in the strangulation group were all significantly greater than the activities seen in the simple obstruction group (P<0.001, for all). In conclusion, increased serum hex levels indicate irreversible transmural infarction only in the late period of strangulation in the closed loop small bowel obstruction model. It seems unuseful for detecting reversible and/or irreversible ischemia in the early period of strangulation.
Similar content being viewed by others
REFERENCES
Morris S, Hays W, Enomoto M, Glew R, Feddersen R, Fry D, Morris D: Serum cytosolic B-glucosidase elavation and early ischemic injury to guinea pig small intestine. Surgery 125(2):202-210, 1999
Okada T, Yoshida H, Iwai J, Matsunaga T: Pulsed dopler sonography for the diagnosis of strangulation. J Pediatr Surg 3:430-435, 2001
Ogata M, Imai S, Hosotani R, Aoyama H: Abdominal USG for the diagnosis of strangulation in small bowel obstruction. Br J Surg 81(3):421-244, 1994
Fevang BT, Fevang J, Stangeland L, Soreide O, Svanes K, Viste A: Complications and death after surgical treatment of small bowel obstruction. Ann Surg 231(4):529-537, 2000
Rahman GA, Mungadi IA: Gangrenous bowel in Nigerians. Centr Afr J Med 46(12):321-324, 2000
Gollin G, Marks C, Marks WH: Intestinal fatty acid binding protein in serum and urine reflects early ischemic injury to the small bowel. Surgery 113:545-551, 1993
Marks WH, Salvino C, Newell K, Wider M, Marks C: Circulating concentrations of porcine ileal peptide but not hexosaminidase are elavated following 1 hour of mesenteric ischemia. Surg Research 45:134-139, 1988
Marks WH, Gollin G: Biochemical detection of small intestinal allograft rejection by elavated circulating levels of serum intestinal fatty acid binding protein. Surgery 114(2):206-210, 1993
Graeber GM, O'Neill JF, Wolf RE, Wukich DK, Cafferty PJ, Harmon JW: Elavated levels of peripheral serum creatinin Phosphokinase with strangulated small bowel obstruction. Arch Surg 118:837-840, 1983
Kanda T, Fujii H, Murakami H, Suda T: I-FABP is a useful diagnostic marker for mesenteric infarction in humans. Gastroenterology 110(2):339-343, 1996
Ozkara HA, Sanhoff K: Characterization of two Turkish β-hexosaminidase mutations causing Tay-Sacs disease. Brain Dev 25:191-194, 2003
Lobe TE, Richardson CJ, Rassin DK, Mills R, Schwartz M: Hexosaminidase: A marker for necrotizing enterocolitis in the preterm infant. Am J Surg 147:49-52, 1984
Lobe TE, Dobkin EE, Rassin DK, Gourley WK, Oldham KT, Bhatia JB: Hexosaminidase: A marker for healing after ischemic gut injury. J Surg Res 40:362-367, 1986
Risueno JC, Gomez-Alonso A, Garcia-Criado FJ, Garcia-Saatre A, Corral J, Cabezas JA, Villar E: Letter to Editor: Effect of anaesthesia and acute intestinal ischemia on serum β-N-acetylhexosaminidase activity in rabbit as biological model. Clin Chim Acta 208:127-131, 1992
O'Brein JS, Okada S, Chen A, Fillerup DL: Tay-Sacs disease: Detection of heterozygotes and homozygotes by serum hexosaminidase assay. N Engl J Med 283(1):15-20, 1970
Harouna Y, Yaya H, Abdou I, Bazira L: Prognosis of strangulated inguinal hernia in the adult: influence of intestinal necrosis: Apr?osu of 30 cases. Bull Soc Pathol Exot 93(5):317-320, 2000
Deutsch AA, Eviatur E: Small bowel obstruction: a review of 264 cases and suggestions for managementt. Postgrad Med J 65(765):463-467, 1989
Otamiri T, Sjodahl R, Tagesson C: An experimental model for studying reversible intestinal ischemia. Acta Chir Scand 153:51-56, 1987
Polson H, Mowat C, Himal GS: Experimental and clinical studies of mesenteric infarction. Surg Gynecol Obstet 153:360-362, 1981
Lobe TE, Schwartz MZ, Richardson CJ, et al.: Hexoseaminidase: a marker for intestinal gangrene in necrotizing enterocolitis. J Pediatr Surg 945-969, 1983
Newmark J, Brady RO, Grimley PM, Gal AE, Waller SG, Thistlethwaite JR: Amygdalin (Laetryl) and prunasin β-glucosidases: distrubution in germ-free rat and in human tumor. Proc Natl Acad Sci USA 78:6513-6516, 1981
Kugaczewski JT, Ziegler MM: Serum hexosaminidase, host age, and nutritinal status. J Ped Surg 21(12):1096-1100, 1986
Risueno JC, Gomez Alonso A, Garcia-Criado FJ, Garcia Sastre A, Corral J, Cabezas JA, Villar E: Effect of anasthesia and acute intestinal ischemia on serum β-n-acetylhexosaminidase activity in rabbit as a biological model. Clin Chim Acta 208:127-131, 1992.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Oruç, M.T., Özmen, M.M., Kazan, O. et al. Does Serum Hexosaminidase Activity Play a Role in the Diagnosis of Strangulated Bowel Obstruction? An Experimental Study. Dig Dis Sci 49, 1681–1686 (2004). https://doi.org/10.1023/B:DDAS.0000043386.84677.0c
Issue Date:
DOI: https://doi.org/10.1023/B:DDAS.0000043386.84677.0c