Interposition of a reversed jejunal segment enhances intestinal adaptation in short bowel syndrome: an experimental study on pigs

J Surg Res. 2011 Dec;171(2):551-7. doi: 10.1016/j.jss.2010.06.035. Epub 2010 Sep 8.


Background: Interposition of a reversed intestinal segment as a factor facilitating intestinal adaptation has been experimentally investigated. Controversy exists about its efficacy in terms of body weight improvement, direction of luminal changes, and underlying mechanisms. This study aims to provide a comprehensive approach.

Methods: The pigs were randomly allocated to two groups: (1) short bowel (SB) group (n=8) and (2) short bowel reverse jejunal segment (SB-RS) group (n=8). On postoperative d 3, 30, and 60, intestinal transit time was measured; body weight and serum albumin were measured on baseline, as well as on postoperative d 30 and 60. After sacrifice, histopathologic and immunohistochemical (PCNA, activated caspase-3) evaluation followed.

Results: Transit time was numerically longer in SB-RS group at all time points; the difference reached statistical significance on d 60. No statistically significant differences were observed concerning body weight or serum albumin. In the SB-RS group, a statistically significant increase in muscle thickness, crypt depth, villus height, and PCNA immunostaining, and a decrease in caspase-3 positive (+) cell count were documented both at the jejunal and ileal level.

Conclusions: The reversed jejunal segment seemed able to enhance intestinal adaptation at a histopathologic level, as well as to favorably modify transit time. These putatively beneficial actions were not reflected upon body weight. The decrease in apoptosis was caspase-3-dependent.

MeSH terms

  • Adaptation, Physiological / physiology*
  • Animals
  • Apoptosis / physiology
  • Body Weight / physiology
  • Caspase 3 / metabolism
  • Cell Division / physiology
  • Disease Models, Animal
  • Gastrointestinal Motility / physiology
  • Ilium / pathology
  • Ilium / physiology
  • Intestinal Mucosa / pathology
  • Intestinal Mucosa / physiology
  • Jejunum / pathology
  • Jejunum / physiology*
  • Jejunum / surgery*
  • Proliferating Cell Nuclear Antigen / metabolism
  • Serum Albumin / metabolism
  • Short Bowel Syndrome / pathology
  • Short Bowel Syndrome / physiopathology*
  • Sus scrofa


  • Proliferating Cell Nuclear Antigen
  • Serum Albumin
  • Caspase 3