Treatment of Uremia by Perfusion of an Isolated Intestinal Loop

In 1946, de Leeuw and Kolff1treated a patient with contracted kidneys and uremia by dialysis through an intestinal loop. A loop of small intestine was separated by transverse sections and the ends brought out through lateral stab wounds, leaving the vasculature intact. The continuity of the remaining intestine was restored by end-to-end anastomosis. The isolated intestinal loop was perfused. Rinsing fluid from a reservoir was let into the proximal end of the intestinal loop after passage through a Murphy drip and through a thermostatically controlled bath to bring it up to body temperature. From this first patient 5 gm. of urea could be removed in 10 hours of perfusion. Since then, all our patients with severe chronic uremia were treated with a forced high-caloric, low-protein diet according to the principle of Borst. Conditions demanding intestinal dialysis rarely occurred.