A Roentgen Study of the Effect of Total Pancreatectomy on the Stomach and Small Intestine of the Dog

Abstract

Numerous and extensive studies (1, 2, 3, 5, 7, 10, 12–15) of extrinsic and intrinsic influences upon the radiologic appearance of the small intestine have revealed that, though the small bowel is sensitive to a multitude of stimuli, it reacts in a limited manner. The finding of an altered motor pattern can therefore rarely be attributed to a definite entity. Limitations of the small-intestinal roentgen examination will continue until the stimuli and the motor changes they produce are more fully understood. Among the factors requiring further study are the internal and external secretions of the pancreas. Loss of external secretions results in partially digested food products, principally proteins and fats. At least some of these products are felt to have a profound influence upon intestinal motor function (8, 15, 16). While these indirect effects of pancreatic enzymes upon the intestinal tract seem established, the direct effects, as measured by an inert water-barium meal, remain to be determined. It is the purpose of this investigation to study the results of exclusion of the internal and external pancreatic secretions upon the gastro-intestinal tract. Materials and Methods Sixteen adult dogs (Table I), after a period of observation on a routine kennel diet, were subjected to complete pancreatectomy by Dr. Jonathan E. Rhoads of the Department of Research Surgery (University of Pennsylvania). Following this, the animals were maintained on a special diet consisting of 20 per cent casein, 10 per cent lard, 66 per cent sucrose, and 4 per cent salt, supplemented with essential vitamins. Insulin was administered according to requirements as indicated by glycosuria. Two dogs (Nos. 577 and 578) not depancreatized, served as controls. All examinations were performed as follows: The dogs were fasted for at least three hours. A tube was passed into the stomach and 100 c.c. of a mixture of equal parts, by volume, of barium sulfate and distilled water was introduced. The tube was then withdrawn and the dog released. Radiographs were made at twenty-minute and fluoroscopic examinations at forty-minute intervals, the dogs being held immobile in the prone position. At all other times the animals were free of restraints. Two or three blood samples were obtained at equally spaced intervals during the post-pancreatectomy examinations for blood sugar determinations. The effect of the blood sugar level on gastric emptying time, tone, and motility, and on small intestinal transit time, tone, and continuity of pattern was studied postoperatively during periods of hyperglycemia (insulin omitted on the morning of the examination), and of hypoglycemia (insulin administered two hours before the examination). Gastric emptying time was taken as the interval from the time of instillation of the barium until the stomach was empty, i.e., when no barium could be seen within the stomach or when only a coating of barium remained on the walls.