Effect of vagotomy upon the small intestine.

Abdominal vagotomy with various drainage procedures , widely used in the surgical treatment of peptic ulcer, may be followed by weight loss, intermittent diarrhoea, and steatorrhoea (Butler and Following section of the vagus nerve in the dog, steatorrhoea and histo-logical and enzymatic abnormalities of the small intestinal mucosa were observed (Ballinger, Iida, Aponte, Wirts, and Goldstein, 1964). In man, barium meal studies revealed dilatation, delayed motility, and flocculation in the small intestine (Isaac, Ottoman, and Weinberg, 1950). Although gallbladder functions have been studied in post-Patient No. Preoperative Diagnosis vagotomy diarrhoea in man (Rudick and Hutchison, 1965), the role of the small intestine in the development of these complications has not been elucidated. Accordingly, the effects of abdominal vagotomy upon the villus architecture and mitotic activity of the crypts of the small intestinal mucosa were studied and correlated with xylose and fat absorption. MATERIALS AND METHODS Six patients with duodenal or marginal ulcers were studied. All underwent bilateral vagotomy and subsequently had some diarrhoea and weight loss (Table I). Five patients with gastric ulcer without diarrhoea served as controls. Biopsies were obtained with the Carey capsule (positioned at the jejunum under fluoroscopic control) preoperatively (six patients), three weeks post-operatively (six patients), and six weeks postoperatively (four patients). The tissue was examined in the fresh state under the dissecting microscope and sections stained with haematoxylin and eosin and alcian blue-P. 1 Duodenal ulcer and gastro-enterostomy 2 Marginal ulcer and gastro-duodenostomy 3 Duodenal ulcer 4 Duodenal ulcer 5 Duodenal ulcer 6 Duodenal ulcer M 41 Abdominal Epigastric fullness, watery diarrhoea, weight loss (10 lb.) vagotomy F 38 Thoracic Epigastric fullness, watery diarrhoea, weight loss (5 lb.) vagotomy M 53 Abdominal Epigastric fullness, watery diarrhoea, weight loss (8 lb.) vagotomy and pyloroplasty M 62 Abdominal Epigastric fullness, steatorrhoea (14 g.), weight loss (16 lb.) vagotomy and partial (50%) gastrectomy M 42 Abdominal Epigastric fullness, watery diarrhoea, weight loss (8 lb.) vagotomy and antrectomy M 58 Abdominal Epigastric fullness, watery diarrhoea, weight loss (15 lb.) vagotomy and partial (50NY) gastrectomy 87