J.Jpn. Surg. Soc.. 60(14): 2153-2163, 1960

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EXPERIMENTAL STUDIES ON THE PERMEABILITY OF INTESTINAL FLORA THROUGH THE BOWEL WALL WHEN THE MESENTERIC CIRCULATION IS ARTIFICIALLY INTERRUPTED

The interruption of mesenteric circulation is often met with, in such cases as incarcerated hernia, strangulation ileus or bowel resection, etc.
Few studies, however, have been given on the subject of when and how the intestinal flora permeates through the bowel wall.
Primarily it has been argued whether the intestinal flora ever permeats or not.
Moreover, clinical observations or animal experiments have been inaccurate in their results on account of the external infection.
Accordingly there have been different opinions about the permeation.
In the first place, I cleared up the external infection and experimented on each part of rabbits' intestine, interrupting their circulation in its various length or with the variety of time after the attack. I cultured the exsudate in the peritoneal cavity and the surface of the serosa and examined the serosa itseIf microscopically. Also I inspected the bowel wall histo-bacteriologically and found a change in the state of the bacterial flora in the intestine after the attack. Expecting the accuracy, I referred the results of all these experiments to one another and pursued the process in which the intestinal flora emerged on the surface of the serosa.
In this way, after the quantitative and morphological investigations on the relationship between the permeability of the intestinal flora and the clinically familiar events-e.g., necrosis, adhesion or fibrinous covering, expansion of bowel, stink in the peritoneal cavity, diarrhoea, etc.-I came to the conclusion as follows.
1) Intestinal bacilli never permeate through the bowel wall without its complete necrosis.
Besides the intestinal flora never emerges on the surface of serosa before 12-14 hours.
2) In about 24 hours the intestinal flora begins to permeate in 100% of the cases of complete necrosis.
3) If the attacked bowel is too short, either not coming to necrosis or being cured gradually, the intestinal flora generally doesn't permeate.
At a certain hour after the operation, the permeability rate is proportional, to some extent, to the length of the regarded intestine.
If the attack is delivered on a certain length of the intestine the rate increases with the lapse of time.
Naturally if the attacked intestine is over a certain length or the duration is over a certain hours, the permeation happens in 100% of the cases.
4) As to the classification of the permeating bacilli, most of them arc bac. coli.
Staphylococci are the next in number of cases. After the lapse of time bac. subtilis begins to emerge.
Within 32 hours, obligate anaerobic bacilli do not emerge.
5) The results of these cultures, of the exsudate in peritoneal cavity, or the serosa scraping or of the scrosa emulsion agree with one another.
Bacilli are difficult to emerge on the surface of serosa; but when once they merge, they do rapidly also in the exsudate in the peritoneal cavity.
6) Comparing the result of direct microscopy of the serosa itself, loosened and stained, with that of the serosa-scraping-culture; there is not so remarkable difference between them in the case of bac. coli. But in the case of Gram (+) bacilli or cocci they are found more frequently on the direct microscopy.
Among the bacilli in the cavity of bowel or in its wall, there are some, deceased or weakened, cannot be cultured. This is apparent especially with bac. subtilis or staphylococcus.
7) As to the permeability rate, there is not so great difference between the small intestine and colon, the rate is very high with appendix. In the small intestine, the rate is a little higher with staphylococcus, in the large intestine with coli-bacillus.
8) If the attacked part is expanded bacilli can easily permeate : cocci among the rest, cannot without the expansion of the bowel.
9) Bacilli are hard to pass through the bowel wall in the case of diarrhoea : Especially cocci are very difficult to permeate.
10) In such cases as there is an intestinal adhesion or fibrinous covering, the permeability is higher than in other cases.
11) When the abdominal cavity stinks, the rate is high; but sometimes it is sterile on the surface of serosa.
Contrary when it doesn't stink, sometimes bacilli can emerge. Cocci are remarkable in this case. When it stinks, coli-bacilli are often found there.
12) Even if the small intestine is necrotised there is scarcely any stink during certain hours. And even then bacilli can appear on the surface of serosa.
In the appendix or large intestine the stink will be easily noticed from the beginning of necrosis.
13) Considering histo-bacteriologically, bacterial flora does not proliferate penetrating the cell of intestinal wall but flows out through spaces of tissues or lymph vessels.
Both bacilli and cocci have mainly the moment by which they are passively pushed and poured out. Selfmovement takes part more or less in this moment in the case of bacilli which have whips.
14) I have studied the reason for the each result mentioned above.
(Author's abstract)

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