Abstract

Some patients with intra-abdominal infection (IAI) may develop intra-abdominal hypertension (IAH) during treatment. The present study investigated the impact of IAI combined with IAH on the intestinal mucosal barrier in a rabbit model. Forty-eight New Zealand white rabbits were randomly divided into four groups: (i) IAI and IAH; (ii) IAI alone; (iii) IAH alone; and (iv) Control group. IAI model: cecal ligation and puncture for 48 h; IAH model: raised intra-abdominal pressure (IAP) of 20 mmHg for 4 h. Pathological changes in intestinal mucosa were confirmed by light and scanning electron microscopy. FITC-conjugated dextran (FITC-dextran) by gavage was used to measure intestinal mucosal permeability in plasma. Endotoxin, d-Lactate, and diamine oxidase (DAO) in plasma were measured to determine intestinal mucosal damage. Malonaldehyde (MDA), superoxide dismutase (SOD), and GSH in ileum tissues were measured to evaluate intestinal mucosal oxidation and reducing state. Histopathologic scores were significantly higher in the IAI and IAH group, followed by IAI alone, IAH alone, and the control group. FITC-dextran, d-Lactate, DAO, and endotoxin in plasma and MDA in ileum tissues had similar trends. GSH and SOD were significantly lowest the in IAI and IAH group. Occludin levels were lowest in the ileums of the IAI and IAH group. All differences were statistically significant (P-values <0.001). IAI combined with IAH aggravates damage of the intestinal mucosal barrier in a rabbit model. The combined effects were significantly more severe compared with a single factor. IAI combined with IAH should be prevented and treated effectively.

Highlights

  • Intra-abdominal infection (IAI), including diffuse peritonitis and abdominal abscess, has the second highest incidence [1] of infectious diseases amongst inpatients

  • We examined pathological changes of the intestinal mucosa, intestinal mucosa barrier function, and intestinal mucosa redox status amongst disparate rabbit models (IAI alone, Intra-abdominal hypertension (IAH) alone, IAI combined with IAH, and control), and explored the effect of IAI combined with IAH on intestinal mucosa barrier function

  • Intestinal mucosa damage was most severe in the IAI and IAH group, and normal intestinal mucosa was observed in the control group

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Summary

Introduction

Intra-abdominal infection (IAI), including diffuse peritonitis and abdominal abscess, has the second highest incidence [1] of infectious diseases amongst inpatients. Despite diagnostic and therapeutic advances over the past decades, the mortality and complication rates of IAI remain high [2]. Intra-abdominal hypertension (IAH) is increasingly acknowledged as a difficult critical illness in clinical practice. The definition of IAH [3] is a sustained or repeated pathological elevation in intra-abdominal pressure (IAP) ≥12 mmHg. Because the rate of IAH morbidity and mortality remains high, it is still an enormous challenge for physicians [3]. For patients who have undergone major abdominal surgery or who have severe abdominal trauma, severe burns, or severe acute pancreatitis, IAI may coexist with IAH [4]. If treatment is not given promptly or is incorrect, patients can develop multiple organ dysfunction syndrome (MODS)

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