Cyclooxygenase-2 and level cryoglobulin significance for small bowel anastomotic leak healing

Author(s): Tymchenko Mykhailo, Ivanova Julia, Gramatiuk Svetlana, Shchur Olha and Lazirskiy Vyacheslav

It is known that the leading pathophysiological aspect in patients with Intestinal Anastomoses (IA) is volemic and hemodynamic disorders, which are caused by the reduction of arterial inflow and impaired venous outflow due to compression of intracellular vessels, and sequestration of fluid. The aim study was to examine role cyclooxygenase‐2 and level cryoglobulin significance of anastomotic leakage.

Material and Methods: From 96 consecutive patients that were selected by the method of random sampling, which performed resections of the segments of the small intestine with the formation of intestinal anastomoses, in the SI “ZIGUS NAMSU” in the period from 2016 to 2018, paraffin‐embedded colonic or rectal tissue sections were collected from the pathology department’s database for DNA extraction.

Cryoglobulin is serum immunoglobulins that re-precipitate at a temperature below 37ºC. Separation of Cryoglobulin from serum was performed by the A.E. Kalovidoris method with modifications.

Results and Discussion: The 96 patients were examined, Cryoglobulinemia (CGE) was detected in the majority -59 (62.5%) patients, 4 of which was subsequently revealed inactive hepatitis C; the remaining 37 patients (38.5%) did not have CGE. In our study, 95% of patients had the first type of CGE that we associate with self-aggregation via the IgFc fragment and 4.2% had the third type of CGE that correlated with the latent form of hepatitis C in these patients. Humans with genetically impaired COX‐2 expression show high anastomotic leakage incidence of 59 patients have is cryoglobulinemiaundergoing intestinal resection, 11 were homozygous for the PTGS2-765G>C polymorphism. Three of 11 (27%) developed anastomotic leakage compared with 14 of 59 (23.7%) patients with the ‐765GC or ‐765GG genotype.

Conclusion: For decades, Cryoglobulin has fascinated investigators and clinicians. The research into this intriguing disorder (anastomotic leakage) weaves together the history of medicine during the last century. Finally, the striking association between COX‐2 and cryoglobulinemia along with the multifaceted clinical expression of this anastomotic leakage relaunch the challenge.