Risk Factors Associated with Acute Sarcopenia in Patients Hospitalized with COVID-19.

Background: The COVID-19 pandemic is an extraordinary global emergency. The pandemic has changed profoundly people's lifestyles. This resulted in reductions in physical activity and changes in dietary intakes that have the potential to accelerate sarcopenia. Objective: The aim of this study was to evaluate the risk factors associated with acute sarcopenia in patients hospitalized with COVID-19. Methods: This was a cross-sectional study conducted from January/2021 to March/2022 in a private hospital in Cuiabá/MT, central region of Brazil. The main variable was the prevalence of acute sarcopenia among adults hospitalized with COVID19. Patients were assessed for acute sarcopenia using the SARC-F ≥4 questionnaire (strength, assistance with walking, rise from a chair, climb stairs, and falls), grip strength (<20 kg (female) and <35 kg (male)), and calf circumference (<33 cm (female) and <34 cm (male)). Results: In all, 213 patients aged 57.4 ± 15.4 years, 63.8% male, were studied. Thirty-four (16.0%) patients were diagnosed with acute sarcopenia. Advanced age (older people) and the percentage of weight lost ≥3% before hospitalization were independent risk factors for acute sarcopenia in hospitalized patients with COVID-19. Conclusion: Acute sarcopenia was present in 16% of patients. Advanced age and percentage of weight lost ≥3% were independent risk factors for acute sarcopenia in patients hospitalized with COVID-19.

Measurement of the thickness of the adductor pollicis muscle as a predictor of outcome in critically ill patients.

OBJECTIVE: Malnutrition is associated with complications and prolonged hospital stay in critically ill patients. We assessed whether the measurement of the thickness of the adductor pollicis muscle (TAPM), a new tool to assess malnutrition is a valuable prognostic indicator in critically ill patients. METHODS: Open cohort study including 248 patients admitted for either medical or surgical intensive care treatment in a tertiary hospital. Two were discharged for having age below 18 years-old and therefore 246 subjects of both sexes completed the entire analysis. Subjective global assessment and APACHE II scores were used to score the patients. TAPM of both hands was measured at admission with a caliper and correlated with mortality, days of mechanical ventilation, and length of hospital stay (LOS). RESULTS: There was a significant correlation (R = 0.84, p < 0.001) between TAPM of the right and the left hand. Severe malnourished patients showed TAPM of both the left (12.3 ± 5.5 mm) and right sides (12.9 ± 5.3 mm) significantly lower (p < 0.001) than either patients scored as nourished (right hand = 17.2 ± 5.4 mm and left hand = 15.8 ± 4.6 mm). Risk of death was approximately 8 times higher in patients with APACHEII score above 20 (OR: 8.6, 95% CI: 3.7-20.2; p < 0.001), and approximately 6 times higher in subjects with abnormal TAPM (OR: 6.3, 95% CI: 1.2-32.6; p = 0.02). However, TAPM did not correlate with length of stay and days of mechanical ventilation. CONCLUSION: TAPM is a valuable tool to predict mortality in critically ill patients.

Enteral or parenteral nutrition in traumatic brain injury: a prospective randomised trial.

INTRODUCTION: Few studies have evaluated the route of nutritional therapy in patients with head trauma. OBJECTIVE: We aimed at investigating whether early enteral (EN) or parenteral nutrition (TPN) may differ in protein/ calorie supply, serum glucose modifications, and acute phase response in patients with traumatic brain injury (TBI). METHODS: Twenty two patients with moderate TBI (Glasgow score between 9-12) were randomized to receive isocaloric and isonitrogeneous either EN (n=12) or TPN (n=10). The daily amount of calories and nitrogen (N) supplied, the nitrogen balance, and the daily serum level of glucose, C-reactive protein, and albumin were collected for 5 consecutive days. Clinical endpoints as length of stay and mortality were also compared. RESULTS: Mortality was 9.1% (two cases) with one case in each group. A progressive caloric deficit occurred in both groups (p=0.001) without difference between them. The mean serum glucose level in TNP patients (134.4, 95% CI=122.6 to 146.2 mg/dl) was significantly higher than in the EN group (102,4; 95% CI 91.6 to 113.2 mg/dL) (p<0.001). There was a trend (p=0.06) of 24 h urinary N loss to be greater in TPN group which received higher amounts of N than the NE group (p<0.05). However, nitrogen balance was similar in the two groups. There was no difference in either the clinical outcome variables or the acute phase response. CONCLUSION: Both routes were able to supply increasing provision of calories to brain injured patients. TPN provided significantly greater amount of nitrogen but losses were also greater. Nitrogen balance was similar with both types of therapy. Parenteral compared to enteral nutrition lead to greater hyperglycemia. There was no influence of the route in both the early inflammatory response and clinical outcome.

Safety of oral glutamine in the abbreviation of preoperative fasting: a double-blind, controlled, randomized clinical trial.

INTRODUCTION: No study so far has tested a beverage containing glutamine 2 h before anesthesia in patients undergoing surgery. OBJECTIVES: The aim of the study was to investigate: 1) the safety of the abbreviation of preoperative fasting to 2 h with a carbohydrate-L-glutamine-rich drink; and 2) the residual gastric volume (RGV) measured after the induction of anesthesia for laparoscopic cholecystectomies. METHODS: Randomized controlled trial with 56 women (42 (17-65) years-old) submitted to elective laparoscopic cholecystectomy. Patients were randomized to receive either conventional preoperative fasting of 8 hours (fasted group, n = 12) or one of three different beverages drunk in the evening before surgery (400 mL) and 2 hours before the initiation of anesthesia (200 mL). The beverages were water (placebo group, n = 12), 12.5% (240 mOsm/L) maltodextrine (carbohydrate group, n = 12) or the latter in addition to 50 g (40 g in the evening drink and 10 g in the morning drink) of L-glutamine (glutamine group, n = 14). A 20 F nasogastric tube was inserted immediately after the induction of general anesthesia to aspirate and measure the RGV. RESULTS: Fifty patients completed the study. None of the patients had either regurgitation during the induction of anesthesia or postoperative complications. The median (range) of RGV was 6 (0-80) mL. The RGV was similar (p = 0.29) between glutamine group (4.5 [0-15] mL), carbohydrate group (7.0 [0-80] mL), placebo group (8.5 [0-50] mL), and fasted group (5.0 [0-50] mL). CONCLUSION: The abbreviation of preoperative fasting to 2 h with carbohydrate and L-glutamine is safe and does not increase the RGV during induction of anesthesia.

Rice bran supplementation during nutritional recovery period of malnourished rats improves colon development.

OBJECTIVE: To investigate the colon's development in rats subjected to protein energy malnutrition followed by supplementation with rice bran. MATERIALS AND METHODS: Weaned Wistar male rats (21 days old), weight (40-50 g) were divided into two groups: diet with 17% protein (C; control group) or an aproteic diet (A; aproteic group), for 12 days. After this, 50% of the rats from each group were sacrificed. The remaining rats were further distributed in the three groups for a recovery (21 days): control (C) continued to receive the control diet whereas the aproteic group (A) received either a control diet (AC) or a control diet supplemented with 5% of rice bran (ARB). RESULTS: The A group showed alterations in the colon and cecum, excreted dry feces mass and fecal nitrogen, compared with C rats. In the proximal colon of A rats, the external muscularis and the width of the colon wall were higher whereas in the distal colon they were lower than C. After the recovery period, the relative cecum mass, colon mass and colon length of the recovered groups (AC and ARB) were higher than in the C group. Dry feces and fecal nitrogen excreted of the rats from recovered groups were lower than C group. Colon length of the AC group was lower than in the C group. Only the crypt's depth from ARB group was higher than in the C group. CONCLUSION: Control diet supplemented with 5% rice bran, reestablished the large intestine of aproteic rats. The recovery in the ARB group was even better than in the AC rats.

Oral glutamine in addition to parenteral nutrition improves mortality and the healing of high-output intestinal fistulas.

OBJECTIVE: Anastomotic leakage is one of the most important causes of morbidity and mortality in gastrointestinal surgery. We investigated the effect of oral glutamine on the healing of high-output intestinal fistula. SETTING: A tertiary Universitary Hospital of the University of Mato Grosso, Cuiaba, Brazil. PATIENTS AND METHODS: 28 patients (25 males and 3 females; median age = 45 [18-71] years old) admitted with high output post-operative small bowel fistulas (median volume in 24 h: 850 [600-2,200] mL) during a 4 years period were retrospectively studied. INTERVENTIONS: In the first two years 19 (67.9%) patients received only TPN as the initial nutritional support. In the last two years however, due to a change in the protocol for the nutritional support in cases of intestinal fistula 9 patients (32.1%) received oral glutamine (0.3 g/kg/day; 150 mL/day) in addition to TPN. Endpoints of the study were mortality, resolution of the fistula, and length of hospital stay (LOS). RESULTS: The overall mortality was 46.4% (13 patients). Fistula closure was observed in all other 15 patients (53.6%) that survived. In the subset of survived patients LOS was similar in those who received or not received glutamine. The multivariate regression analysis showed that resolution of the fistula was 13 times greater in patients that received oral glutamine (OR = 13.2 (95% CI = 1.1-160.5); p = 0.04) and 15 times greater in non-malnourished patients (OR = 15.4 [95% CI = 1.1-215.5]; p = 0.04). CONCLUSIONS: We conclude that oral glutamine accelerated the healing and diminished the mortality in this series of patients with post-operative high-output intestinal fistula receiving TPN.

Evolution of nutritional therapy prescription in critically ill patients.

AIM: The aim of this study was to investigate factors that may affect the evolution of the caloric prescription in critically ill patients. Local: Intensive care unit patients. PATIENTS: 60 patients (33 M and 27 F); median age = 49 (1593) y were followed prospectively. They were divided in three groups according to the diagnostic: (a) trauma (n=20); (b) surgical (n=22), and 3) medical treatment (n=18). Forty-and-one (68.3%) patients received enteral nutrition (EN), 17 (28.3%) parenteral nutrition (TPN), and 2 (3.4%) TNP and EN. Nutritional status was graded B or C by global subjective evaluation. METHODS: Endpoints of the study were the time to begin the nutritional support, success or failure of the caloric prescription, and the evolution of the planned caloric prescription. The caloric evolution was considered as success if the prescription for the patient attained: (a) 25% of the caloric requirements on the 1st day; (b) 50% until the 3rd day; (c) 75% until the 6th day; and (e) 100% until the 10th day of the beginning of the support. RESULTS: In 54 (90%) patients, the nutritional support has begun until 48 h after admission and in 73.3% (44 patients), until the first 24 hours. EN was most prescribed for both trauma and medical patients while NPT was most used for surgical patients (p < 0.01). Success in caloric prescription was obtained in 73.3% (44) of the patients. There was no statistical difference for the success on the evolution of the prescription related to sex, age, diagnostic group, albumin level, type of support, mortality, use of fiber or glutamine. Success was attained earlier in patients without (median = 3.8 [95% CI, 5.7-16.7] days) than with (11.2 [95% CI, 5.7-16.7] days; p < 0.01) mechanical ventilation. CONCLUSIONS: Early nutritional support and success on the evolution of the caloric prescription can be accomplished in most critically ill patients. Evolution of the caloric prescription was slower in mechanical ventilated patients.

Benefits of intraluminal injection of glutamine for intestinal mucosa during ischemia-reperfusion.

BACKGROUND: We investigated the effect of intraluminal glutamine on the intestinal mucosa in the presence of ischemia-reperfusion injury (IRI). METHODS: Six blind sacs were created in the small bowel (3 at the jejunum and 3 at the ileum) in 10 Wistar rats. The lateral sacs of both bowel regions were submitted to IRI (30/30 min), while the medial sacs were left free to receive blood supply. In the lateral sacs, a solution containing either saline plus 4% glutamine or pure saline was injected at the bowel lumen. No fluid was injected in the medial sacs. RESULTS: Both at the jejunum and at the ileum, the score of the mucosal injury was higher in saline-injected sacs than in either glutamine-injected or control sacs. There was a significantly greater number of neutrophils in the sacs treated with saline than in the other two groups of sacs. CONCLUSION: Glutamine protects the mucosa and diminishes the accumulation of neutrophils at the lamina propria of the small bowel in IRI.

[Deflazacort and colonic anastomotic healing. An experimental study in rats]. / Deflazacort e cicatrização de anastomoses colônicas. Estudo experimental em ratos.

BACKGROUND: Deflazacort, a new corticosteroid is claimed to induce less collateral effects than other corticoids. The aim of this study was to investigate the effect of this drug on the healing of colonic anastomosis. MATERIAL AND METHOD: 75 Wistar rats were randomized to receive daily by gavage, one of the following treatments: control group (N=24) - 1 ml of saline; deflazacort (N=25) - 1 ml of this drug containing 0.15mg/ml (0,1 mg/kg/day), and dexamethasone (N=26) - 1 ml containing 0.03 mg/ml of this drug (0.5 mg/kg/day). After 6 days of treatment, the animals underwent laparotomy followed by section and immediate colonic anastomoses in a point 2 cm above peritoneal reflexion. Treatment in each group was carried out until the animals were killed on the third of a six postoperative day. At necroscopy, signs of peritonitis and anastomotic dehiscence were registered. Anastomotic site was tested for tensile rupture and biopsies containing all layers were sent for hydroxyproline and protein measurements. RESULTS: There was no difference in the peritonitis and anastomotic dehiscence rates among the groups. Bowel rupture pressure was similar at day 3 but significantly higher in controls (180 [150-230] mmHg) than in deflazacort (150 [120-180] mmHg) and dexamethasone groups (140 [100-180] mmHg) at day 6. No difference occurred in the hydroxyproline concentration. Protein content was higher in dexamethasone group than in controls on the third postoperative day. CONCLUSIONS: Corticosteroids may impair colonic anastomotic resistance and deflazacort may have similar deleterious effects of dexamethasone in anastomotic healing.

Deflazacort e cicatrizaçao de anastomoses colônicas: estudo experimental em ratos / Deflazacort and colonic anastomotic healing: an experimental study in rats

OBJETIVO: O deflazacort é um novo corticóide com os mesmos efeitos antiinflamatórios dos demais, porém com menos efeitos colaterais. O objetivo deste estudo foi investigar os efeitos do deflazacort na cicatrizaçao de anastomoses colônicas. MATERIAL E MÉTODO: 75 ratos Wistar foram randomizados em três grupos para receberem os seguintes tratamentos por gavagem: grupo controle (N=24)= soluçao fisiológica; grupo deflazacort (N=25)= 0,1 mg/Kg/dia dessa droga e, grupo dexametasona (N=26)= 0,5 mg/Kg/dia substância. Após seis dias de tratamento, os animais foram submetidos à secçao colônica, seguida de anastomose primária em um ponto situado a 2 cm acima da reflexao peritoneal. O tratamento com as soluçoes foi mantido até o sacrifício, que ocorreu no 3o. ou no 6o. dia de PO. Observou-se na necrópsia sinais de peritonite e deiscência de sutura. Realizou-se o teste de pressao de ruptura das anastomoses e dosou-se nessa regiao a concentraçao de hidroxiprolina e proteinas. RESULTADOS: Nao houve diferença em relaçao à ocorrência de deiscência e peritonite. A pressao de ruptura foi semelhante no 3o. dia. No 6o. dia, ela foi maior (p <0.05) no grupo controle (180 [150-230] mmHg) que nos grupos deflazacort (150 [120-180] mmHg) e dexametasona (140 [100-180] mmHg). Nao ocorreu diferença entre os grupos na dosagem de hidroxiprolina. A dosagem de protéinas foi maior no grupo dexametasona que nos controles no 3o. PO. CONCLUSOES: O uso de corticóides determina queda na resistência da anastomose colônica. O deflazacort apresenta os mesmos efeitos deletérios da dexametasona na cicatrizaçao de anastomoses intestinais

Enhanced mucosal re-epithelialization induced by short chain fatty acids in experimental colitis.

The short chain fatty acids (SCFA) are the best nutrients for the colonocytes. Glucose is poorly used as a fuel but may be transformed into SCFA by colonic bacteria. The aim of this study was to investigate the effect of SCFA or glucose on experimental colitis. Colitis was induced in 30 Wistar rats by colonic instillation of 4% acetic acid. Five days later they were randomized to receive twice a day colonic lavage containing saline (controls, N = 10), 10% hypertonic glucose (N = 10) or SCFA (N = 10) until day 8 when they were killed. At autopsy, the colon was removed and weighed and the mucosa was evaluated macro- and microscopically and stripped out for DNA assay. Data are reported as mean +/- SD or median [range] as appropriate. All animals lost weight but there was no difference between groups. Colon weight was significantly lower in the SCFA group (3.8 +/- 0.5 g) than in the control (5.3 +/- 2.1 g) and glucose (5.2 +/- 1.3 g) groups (P<0.05). Macroscopically, the severity of inflammation was less in SCFA (grade 2 [1-5]) than in control (grade 9 [4-10]) and glucose-treated (grade 9 [2-10]) animals (P<0.01). Microscopically, ulceration of the mucosa was more severe in the glucose and control groups than in the SCFA group. The DNA content of the mucosa of SCFA-treated animals (8.2 [5.0-20.2] mg/g of tissue) was higher than in glucose-treated (5.1 [4.2-8.5] mg/g of tissue; P<0.01) and control (6.2 [4.5-8.9] mg/g of tissue; P<0.05) animals. We conclude that SCFA may enhance mucosal re-epithelialization in experimental colitis, whereas hypertonic glucose is of no benefit.

Enhanced mucosal re-epithelialization induced by short chain fatty acids in experimental colitis

The short chain fatty acids (SCFA) are the best nutrients for the colonocytes. Glucose is poorly used as a fuel but may be transformed into SCFA by colonic bacteria. The aim of this study was to investigate the effect of SCFA or glucose on experimental colitis. Colitis was induced in 30 Wistar rats by colonic instillation of 4 percent acetic acid. Five days later they were randomized to receive twice a day colonic lavage containing saline (controls, N = 10), 10 percent hypertonic glucose (N = 10) or SCFA (N = 10) until day 8 when they were killed. At autopsy, the colon was removed and weighed and the mucosa was evaluated macro- and microscopically and stripped out for DNA assay. Data are reported as mean + or -SD or median [range] as appropriate. All animals lost weight but there was no difference between groups. Colon weight was significantly lower in the SCFA group (3.8 + or - 0.5 g) than in the control (5.3 + or - 2.1 g) and glucose (5.2 + or - 1.3 g) groups (PP<0.05). Macroscopically, the severity of inflammation was less in SCFA (grade 2 [1-5]) than in control (grade 9 [4-10]) and glucose-treated (grade 9 [2-10]) animals (P<0.01). Microscopically, ulceration of the mucosa was more severe in the glucose and control groups than in the SCFA group. The DNA content of the mucosa of SCFA-treated animals (8.2 [5.0-20.2] mg/g of tissue) was higher than in glucose-treated (5.1 [4.2-8.5] mg/g of tissue; P<0.01) and control (6.2 [4.5-8.9] mg/g of tissue; P<0.05) animals. We conclude that SCFA may enhance mucosal re-epithelialization in experimental colitis, whereas hypertonic glucose is of no benefit

Collagen variation during experimental acute obstruction of the left colon.

BACKGROUND/AIMS: The colonic response to obstruction is poorly understood. Thickening of the proximal bowel following colonic stricture may be due to increased protein synthesis. We have investigated the colonic morphology and collagen concentration during the development of left-sided colonic obstruction in an animal model. METHODS: Twelve male Wistar rats received either a silk ligature obstruction of the colon 2.5 cm above the peritoneal reflection (n = 6) or manipulation of the left colon (controls, n = 6). Twenty-four hours later, three colonic specimens from the ligature zone and from 1 cm proximal and distal to this site, or from equivalent regions in controls, were assayed for hydroxyproline concentration. RESULTS: In controls there was no difference in hydroxyproline concentration between colonic sites. In obstructed rats, the hydroxyproline concentration was greater both at the ligature and distally, when compared with the proximal region. The hydroxyproline concentration was higher (p < 0.05) than corresponding control values at the ligature site (14.95 +/- 2.76 vs. 10.97 +/- 1.95 microgram/mg of dry tissue mean +/- s.d.) but not on either side. CONCLUSION: The colonic collagen concentration is equivalent or raised near an obstruction, demonstrating that obstructed colon may possess an enhanced capacity to hold sutures.

Effect of an elemental diet on the mechanical resistance and morphology of the colon in rats.

The aim of this study was to investigate the effect of an elemental diet (ED) on colonic morphology and mechanical resistance. Rats received either laboratory chow (control group; n=6) or oral total parenteral nutrition solution (ED group; n=6). After 14 d the colon was measured and weighed with and without the contents. Bursting pressure was determined in the right and left colon. Samples of these segments were examined histologically. Crypt depth and wall width (WW) were measured. All animals gained body weight. The bowels of ED-fed animals were shorter (23.7+/-1.6 versus 19.7+/-1.8 cm; P=0.003) and weighed less than the controls either with (10.3+/-0.8 versus 5.0+/-0.7g, P < 0.001) or without (4.9+/-0.9 versus 2.6+/-0.3 g; P < 0.001) feces. Bursting pressure was lower in animals receiving ED compared with controls (right colon: 250+/-30 versus 200+/-30 mm Hg; P=0.03; left colon: 195+/-22 versus 160+/-14 mm Hg; P=0.009). Crypt depth and WW were significantly shorter in the left colon in the ED group. Administration of ED promotes lack of mechanical resistance and atrophy of the colonic wall, especially in the left colon.

Effect of intraoperative nutritional solutions on perianastomotic colonic mucosa in experimental large bowel obstruction.

We investigated the effect of intraoperative lavage with various solutions on the morphology of the mucosa adjacent to the anastomosis performed in left-sided colonic obstruction. After 24 hr of ligature obstruction to the pelvic colon, 108 male Wistar rats underwent colonic resection followed by primary anastomosis and were randomized for lavage with one of four different solutions: saline, povidone-iodine, 10% hypertonic glucose (HG), and short-chain fatty acids (SCFA). A control group had no lavage. The anastomotic region was studied both macroscopically and with light microscopy after three or six days. At day 3, lavaged animals, especially those with SCFA, had significantly smaller ulcers than controls, and at day 6 only rats lavaged with SCFA and HG were free of large ulcers. At day 3, median (interquartile range) crypt depth was higher in SCFA [360 (286-374) microm] and HG animals [306 (279-315) microm] when compared with controls [243 (225-252) microm; P < 0.05], and SCFA [67 (53-89)] rats showed more cells per crypt than controls [48 (39-52); P < 0.05]. No differences occurred on the sixth day. We conclude that intraoperative lavage with nutrient solutions, particularly with SCFA, has a trophic effect on the colonic mucosa. The suture line gap in the mucosa may be filled more quickly, thus contributing to improve the healing of a colonic anastomosis.

Enhanced intra-anastomotic healing by operative lavage with nutrient solutions in experimental left-sided colonic obstruction.

The influence of intraoperative lavage with various solutions was tested on the healing of experimental colonic anastomoses performed in the presence of obstruction. After 24 h of ligature obstruction to the pelvic colon, male Wistar rats (n = 108) underwent colonic resection and primary anastomosis, using lavage with one of four different fluids: saline, povidone-iodine, 10 per cent hypertonic glucose and short-chain fatty acids (SCFA). Controls had no lavage. The anastomotic segment was excised and studied after 3 or 6 days. At day 3, mean(s.d.) bursting pressure was significantly greater in animals receiving SCFA compared with controls (81.2(23.0) mmHg versus 34.8(34.0) mmHg). Mean(s.d.) bowel wall tension was higher in rats with SCFA (30.6(8.1) N/m x 10(-4) or hypertonic glucose (29.5(10.1) N/m x 10(-4) compared with controls (12.2(12.1) N/m x 10(-4). By day 6, the anastomosis was more resistant to intraluminal pressure in each lavage group; mean(s.d.) hydroxyproline concentration at the anastomosis was greater in rats with SCFA (12.4(1.5) micrograms/mg) or hypertonic glucose (11.6(2.9) micrograms/mg) than in controls (8.9(1.5) micrograms/mg). Anastomotic healing is improved by all types of intraoperative colonic lavage, particularly with SCFA and hypertonic glucose solutions.

The influence of peroperative irrigation of the obstructed left colon in the healing of primary anastomosis: an experimental study in rats

A mortalidade observada na obstrucao aguda do colon esquerdo e alta quando o classico procedimento em tres tempos e realizado. Em recentes relatos na literatura, a utilizacao da irrigacao per-operatoria permite a realizacao de uma resseccao primaria, seguida de anastomose num unico tempo nesses casos. Na tentativa de verificar esta afirmacao, estudou-se experimentalmente, atraves de parametros fisicos e morfologicos, a cicatrizacao de anastomoses realizadas em vigencia de obstrucao aguda do colon esquerdo, valendo-se ou nao da irrigacao per-operatoria. A obstrucao foi associada com um significativo atraso no processo de cicatrizacao da mucosa nos exames macro e microscopicos da mucosa (p<0,05), porem resultados intermediarios foram observados com uso da irrigacao per-operatoria do colon. Conclui-se que a cicatrizacao esta retardada nas anastomoses realizadas na vigencia de obstrucao, porem a irrigacao per-operatoria minimiza esta condicao adversa.