Septic shock reduces intestinal microcirculation and anastomotic perfusion: A porcine laser speckle contrast imaging study

doi:10.4240/wjgs.v18.i1.111928

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Surg. Jan 27, 2026; 18(1): 111928
Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.111928

Septic shock reduces intestinal microcirculation and anastomotic perfusion: A porcine laser speckle contrast imaging study

Rupan Paramasivam, Claudia Jaensch, Nickolai M Kristensen, Susie Sarah Paramasivam, Helen Woldeselassie, Louise Kruse Jensen, Anders Husted Madsen, Mai-Britt Worm Ørntoft

Rupan Paramasivam, Nickolai M Kristensen, Helen Woldeselassie, Anders Husted Madsen, Mai-Britt Worm Ørntoft, Department of Surgery, Godstrup Hospital, Herning 7400, Midtjylland, Denmark

Claudia Jaensch, Department of Surgical Research, Regional Hospital West Jutland, Herning 7400, Midtjylland, Denmark

Susie Sarah Paramasivam, Department of Clinical Medicine, Aarhus University, Aarhus 8000, Midtjylland, Denmark

Louise Kruse Jensen, Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen 2200, Hovedstaden, Denmark

Author contributions: Paramasivam R contributed to formal analysis, investigation, resources, data curation, writing - original draft, visualization, and funding acquisition; Kristensen NM, Paramasivam SS and Woldeselassie H contributed to investigation and writing, review, and editing; Jensen LK, Jaensch C and Madsen AH contributed to conceptualization, methodology, supervision, writing, review, and editing; Ørntoft MBW contributed to conceptualization, methodology, supervision, writing - original draft, and writing - review and editing.

Institutional animal care and use committee statement: All animal procedures were approved by the Danish Animal Experiments Inspectorate and conducted under the supervision of licensed veterinary staff at the Department of Animal Science, Aarhus University (AU Foulum), Denmark. The study was conducted in accordance with national regulations for animal research and was approved by the Danish Animal Experiments Inspectorate (Approval No. 2022-15-0201-01331).

Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this study.

ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.

Data sharing statement: All data generated or analyzed during this study are included in the published article and its Supplementary material files. Further inquiries can be directed to the corresponding author.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Rupan Paramasivam, MD, Researcher, Department of Surgery, Godstrup Hospital, Hospitalsparken 15, Herning 7400, Midtjylland, Denmark. ruppar@rm.dk

Received: July 14, 2025
Revised: August 6, 2025
Accepted: November 27, 2025
Published online: January 27, 2026
Processing time: 192 Days and 12.6 Hours

Abstract

BACKGROUND

Septic shock disrupts systemic and organ-specific microcirculation, leading to poor tissue perfusion and impaired healing. While mesenteric hemodynamics have been studied, the impact of sepsis on intestinal microcirculation and anastomotic healing remains unclear.

AIM

To assess the short-term effects of septic shock on microcirculation in the small intestine and colon, with a focus on hand-sewn and stapled anastomoses, using laser speckle contrast imaging (LSCI).

METHODS

Ten pigs underwent midline laparotomy with the creation of four anastomoses: One hand-sewn and one stapled anastomosis in both the small intestine and colon. LSCI measurements were taken before anastomosis formation (T_B), immediately after (T_A), and after one hour of rest (T₀). Septic shock was induced via intravenous Escherichia coli infusion, with subsequent LSCI measurements at 30-minute intervals (T₃₀-T₁₅₀). Results were expressed as relative changes compared to T_B.

RESULTS

Septic shock significantly reduced microcirculation in both untouched intestine and anastomoses. Hand-sewn anastomoses consistently exhibited higher perfusion than stapled anastomoses. At T₁₅₀, perfusion in hand-sewn anastomoses remained significantly higher than in stapled anastomoses (51% vs 34% of T_B, P = 0.002).

CONCLUSION

This study shows that septic shock significantly impairs intestinal microcirculation indicating a risk of intestinal ischemia if bacteriaemia and subsequent septic shock is untreated. Due to diminish blood flow following septic shock, the anastomotic healing may be compromised leading to increased risk of anastomotic leakage. Conclusively, this study provides a foundation for optimizing surgical strategies and improving patient outcomes in this high-risk population.

Keywords: Sepsis; Intestinal anastomoses; Microcirculation; Anastomotic perfusion; Porcine model; Laser speckle contrast imaging

Core Tip: Septic shock profoundly affects intestinal blood flow, yet its impact on surgical anastomoses remains unclear. In this study, we used laser speckle contrast imaging in a porcine model to assess microcirculation in the small intestine and colon during induced septic shock. We demonstrate a significant reduction in microcirculation, especially at anastomotic sites, with hand-sewn anastomoses maintaining higher perfusion than stapled ones. These findings highlight the potential risk of impaired anastomotic healing during sepsis and emphasize the importance of optimizing surgical strategies in septic patients.