Ultrastructural mucosal injury after experimental ischemia of the ascending colon in horses

The ultrastructural injury that develops sequentially in the ascending colon during experimentally induced ischemia was examined in 6 halothane-anesthetized horses. Colonic ischemia was created by 2 types of vascular occlusion 24 cm proximal and distal to the pelvic flexure. In all horses, transmural vascular compression was created. The colonic venous circulation was obstructed in 3 horses, whereas in the other 3 horses, arterial and venous circulation was obstructed. Two additional horses were anesthetized as controls for determination of any morphologic alterations associated with the experimental protocol. Full-thickness colonic biopsy specimens were obtained from the antimesenteric border of the pelvic flexure at 0, 0.25, 0.5, 1, 1.5, 1.75, 2, 2.25, 2.5, 3, 3.5, 4, 4.5, and 5 hours during occlusion, and were studied by light and transmission electron microscopy. Morphologic alterations did not develop in the colon of control horses. Mucosal congestion was observed by light microscopy in the colon of horses with experimentally induced ischemia, but congestion developed early in those with obstructed colonic venous circulation, compared with those having arterial and venous obstruction. Inter- and intracellular vacuolation and loss of staining initially resulted in groups of 3 to 5 superficial luminal epithelial cells. Alterations in the glandular epithelium lagged behind those in the superficial epithelium, but were observed in both groups by 2 hours of obstruction. These changes progressed to 100% sloughing of all epithelium by 4.5 to 5 hours. The initial cellular alterations, which were observed by transmission electron microscopy, developed at 0.25 hour in horses with colonic venous obstruction and was characterized by inter- and intracellular edema. By 1 hour in horses with colonic venous obstruction, vacuoles were observed within the basal lamina and some vacuoles contained intracellular organelles. These cellular changes were followed by increases in the intercellular gap and breaks between degenerating and more normal-appearing superficial epithelium, which led to sloughing of the epithelium. Endocrine cells by 1 hour also had evidence of ischemic injury. Injury to the vascular circulation, including congestion and platelet accumulations within the mucosal capillaries was apparent by 0.25 hour in horses with venous obstruction. By 1 to 1.5 hours in both groups of horses with experimentally induced ischemia, loss of vascular integrity and leukocyte migration frequently were observed. Platelets, proteinaceous material, and cellular debris continued to accumulate, and by 2.25 hour capillary plugging frequently was observed. These results indicated that the initial ultrastructural injury in the ischemic colon consisted of degenerative changes in epithelial cells, which led to sloughing of degenerating and necrotic cells. Although injury between the 2 types of vascular obstruction differed, end results were similar. Ischemic vascular injury may lead to further vascular thrombosis and necrosis, resulting in an irreversible injury or contribute to difficulty in medically managing horses with natural ischemia during the perioperative period.