A 24-h pneumoperitoneum leads to multiple organ impairment in a porcine model.
BACKGROUND
An intra-abdominal pressure (IAP) of 15 mm Hg reduces intestinal organ perfusion in humans and animals, but it is unknown whether this results in organ damage. The purpose of this study was to evaluate if an IAP of 15 mm Hg lasting for 24 h in a porcine model will lead to morphologic impairment of intestinal and adjacent organs.


METHODS
We examined 12 intubated and anesthetized domestic pigs (51.8 +/- 4.4 kg). Using CO2 pneumoperitoneum, the IAP was raised to 15 mm Hg (study group, n = 6) for an investigation period of 24 h. In the control group, the IAP remained unchanged. Investigated parameters were cardiac output (CO), peak inspiratory pressure (PIP), and urine output (UO), as well as serum creatinine, alanine aminotransferase (ALT), lactate, lipase, and alkaline phosphatase (AP). Additionally, histopathological examinations were performed.Results. In comparison to the control, CO did not change, while UO decreased significantly by 59% and PIP increased significantly to more than 30 mbar. Serum ALT and AP increased significantly while there was no change in creatinine, lactate, and lipase. Histopathologically, low-grade liver necrosis (12% of liver lobuli), low-grade proximal tubular epithelial necrosis, and low bowel mucosal damage were observed.Conclusion. In this porcine model, an IAP of 15 mm Hg lasting for 24 h was found to result in functional and morphologic impairment of lungs, liver, kidneys, and bowel. These results imply that a prolonged IAP of 15 mm Hg predisposes to multiorgan dysfunction and that a safe duration of increased IAP still has to be determined.
Department of Surgery, Rhenish Westphalian Technical University, 52057 Aachen, Germany.
A
A
Schachtrupp
Ch
Ch
Toens
J
J
Hoer
B
B
Klosterhalfen
A G
AG
Lawong
V
V
Schumpelick
D000469:Alkaline Phosphatase / Q000097:blood; D000818:Animals; D001794:Blood Pressure; D002302:Cardiac Output; D002496:Central Venous Pressure; D003161:Compartment Syndromes / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D003404:Creatinine / Q000097:blood; D004195:Disease Models, Animal; D006973:Hypertension / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D007511:Ischemia / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D019344:Lactic Acid / Q000097:blood; D008049:Lipase / Q000097:blood; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D011027:Pneumoperitoneum / Q000150:complications* / Q000473:pathology / Q000503:physiopathology*; D013552:Swine; D014556:Urine; D014781:Viscera / Q000473:pathology / Q000503:physiopathology
D019344:Lactic Acid; D003404:Creatinine; D008049:Lipase; D000469:Alkaline Phosphatase