title: The physical nature of a large bowel perforation predicts severity of the subsequent inflammatory response.
abstract: The aim of the study was to determine how the physical nature of a large bowel perforation influences the host inflammatory response. Two rat models were used: a 4 mm cecal perforation (CP) and a cecal ligation with 23 gauge needle puncture (CLP). CP gave a more fulminant course and this was reflected in higher levels of bacteria, endotoxin, tumor necrosis factor, interleukin-1 (IL-1), and IL-6, which were all strongly compartmentalized in the peritoneal cavity. Despite a sustained enhancement of cytokines in peritoneal fluid, only a temporary burst of tumor necrosis factor, and no release of IL-1, were seen in serum, whereas IL-6 was continuously released. Depletion of leukocytes was more pronounced in CP than CLP. In summary, a large bowel perforation like CP triggers an overwhelming host reaction with leukocytopenia, cytokine release, dehydration, hypoperfusion, and death. The smaller fecal inoculum in CLP gives a more subacute inflammatory response.
authors.affiliation: Norwegian Radium Hospital, Oslo.
authors.forename: R
authors.initials: R
authors.lastname: Lundblad
authors.forename: P
authors.initials: P
authors.lastname: Sandven
authors.forename: K E
authors.initials: KE
authors.lastname: Giercksky
mesh_terms: D000818:Animals; D016470:Bacteremia / Q000209:etiology / Q000401:mortality; D003106:Colon / Q000293:injuries*; D003603:Cytotoxins / Q000097:blood; D004731:Endotoxins / Q000097:blood; D008297:Male; D011379:Prognosis; D051381:Rats; D017208:Rats, Wistar; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*
chemical_list: D003603:Cytotoxins; D004731:Endotoxins