Septic Shock reduces overall Intestinal Microcirculation and specifically Anastomotic Perfusion: Insights from a Porcine Model Using Laser Speckle Contrast Imaging

Abstract Septic shock can severely compromise intestinal perfusion, increasing the risk of poor anastomotic healing and surgical complications. This study investigated the effects of septic shock on intestinal microcirculation and anastomotic perfusion in a porcine model using Laser Speckle Contrast Imaging. Ten pigs underwent laparotomy with creation of four anastomoses— one hand-sewn and one stapled in both small intestine and colon. Microcirculatory measurements were taken before and after anastomosis formation, and repeatedly during the development of septic shock induced by intravenous Escherichia coli infusion. Septic shock led to a significant reduction in microcirculation across both untouched bowel and anastomoses. Hand-sewn anastomoses maintained higher perfusion than stapled anastomoses throughout all time points. 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.