MORPHOLOGICAL CHANGES IN THE SMALL INTESTINE OF RATS WITH ACUTE GENERALIZED PERITONITIS

Introduction. There are evidence that oxidative stress is involved in the pathogenesis of the acute generalized peritonitis and diabetes mellitus.The aim of study was to examine levels of the products of lipid peroxidation and the antioxidants in rats with experimental acute generalized peritonitis against the background of streptozotocin-induced diabetes.Material and methods. The experiment was performed on 66 adult white male rats weighing 220-300 g. Diabetes mellitus in experimental animals was simulated by a single intraperitoneal injection of streptozotocin (Sigma) at the dose of 60 mg/kg. Acute generalized peritonitis was induced with 10% faecal suspension in a dose of 0.5 ml per 100 g of animal weight in the abdominal cavity of laboratory animals by puncture method. The thiobarbituric acid reactive substances (TBARS), lipid hydroperoxides (LOOHs), superoxide dismutase (SOD) activity, catalase (CAT) and ceruloplasmin (CP) were estimated and compared.Results. Our results showed that during all stages of development of acute generalized peritonitis on the background of streptozotocin-induced diabetes there is the LOOHs decrease and the TBARS increase. We observed statistically significant inverse correlations between the level of LOOHs and SOD in the animals of subgroup 1 (r = -0.88; p <0.05) and inverse correlations between the TBARS level and the SOD level in the subgroup 3 of animals (r = -0.74; p <0.05). We also found a statistically significant inverse correlation between the CAT level and the TBARS level (r = -0.86; p <0.05) and between the CP level and the TBARS level in the blood of animals in the subgroup 3 (r = -0.87; p <0.05).Conclusion. Negative statistically significant correlations between the TBARS level and the antioxidants (SOD, CAT, CP) in the blood of animals with acute generalized peritonitis on the background of streptozotocin-induced diabetes indicate a predictor role of lipid peroxidation processes in the depletion of antioxidant resources

The article discusses the issues about the effect of the Armadin on the hepatic transaminase in rats with acute generalized peritonitis on the background of diabetes mellitus. The experiment was performed on 48 white male adult rats, which were divided into two groups. The experimental group – animals with simulated acute generalized peritonitis against the background of streptozotocin-induced diabetes with the drug “Armadin” (ethylmethylhydroxypyridine succinate) application (n=24). The control group – animals with simulated acute generalized peritonitis against the background of streptozotocin-induced diabetes without pharmacocorrection (n = 24). Diabetes mellitus was simulated by a single intraperitoneal injection of streptozotocin at the dose of 60 mg/kg. Acute generalized peritonitis was induced with 10% faecal suspension in a dose of 0.5 ml per 100 g of animal weight in the abdominal cavity of laboratory animals by puncture method. Every day for 6 days, rats of experimental group received the drug “Armadin” at the doses of 100 mg/kg. We found a probable decrease in aminotransferase activity on day 3 of the study in rats of the experimental group after administration of Armadin. Thus, ALT activity decreased by 26.7%, and AST activity – by 25.9% compared to the control group. On the 7th day of the study, the activity of ALT in the blood of rats of the experimental group decreased to 0.50 ± 0.03 mmol/l, which was 49.5% lower than the control group of rats in this period of the experiment. Similar changes are observed in the study of AST activity, where, accordingly, it decreased by 48 % relative to control. The positive effect of the drug "Armadin" on the body of rats, with AGP on the background of STZ-induced diabetes, is manifested by the restoration of the functional state of the liver.

Modern aspects of the pathogenesis of acute inflammation of the peritoneum that is concurrent with diabetes involves analysis of metabolic mechanisms, in particular peroxidaton of proteins – antioxidant defense. Therefore, the objective of our study was to examine the interrelation between the processes of free-radical oxidation of proteins and antioxidant system in the dynamics of development of acute generalized peritonitis against the background of streptozotocin-induced diabetes. The study was performed on 56 non-linear white mature male rats. Diabetes mellitus was modeled by a single intraperitoneal injection of streptozotocin (60 mg/kg). On the 14th day of the development of streptozotocin-induced diabetes, we injected 10% filtrated faeces suspension (0.5 mL) into the abdominal cavity, thus initiating acute generalized peritonitis. Oxidative modification of proteins in blood serum was studied using the I. F. Meshchyshen’s method and the condition of antioxidant protection was monitored according to the activities of superoxide dismutase, catalase, content of reduced glutathione, and the level of ceruloplasmin. The study of the parameters of free-radical oxidation of proteins and study of the condition of antioxidant system in blood of the rats with experimental acute generalized peritonitis against the background of streptozotocin-induced diabetes demonstrated that oxidative protein modification grew, while the parameters of the activity of antioxidant system were being inhibited, depending on the stage of acute inflammation of the peritoneum. We determined inverse correlation relationships between the products of free-radical oxidation of proteins and parameters of antioxidant system on the third and on the seventh days of modelling of combined pathology. Manifestation of acute generalized peritonitis concurring with streptozotocin-induced diabetes was accompanied by a gradual accumulation of the products of free-radical oxidation of proteins and exhaustion of the antioxidant defense during all stages of the development of acute inflammation of the peritoneum, peaking on the seventh day after administration of faecal suspension (terminal stage of peritonitis). The observed inverse correlations between the levels of oxidative modification of proteins and the activity of superoxide dismutase, catalase, reduced glutathione, and ceruloplasmin on the third and on the seventh days of modelling of combined pathology indicate a predictive role of the processes of free-radical oxidation of proteins in exhaustion of antioxidant-defense resources.

The aim of the work: to analyze the microbiota and to study the morphological structure of the small intestine in the dynamics of acute peritonitis on the background of streptozotocin-induced diabetes mellitus. Materials and methods. Experimental researches were performed on 52 adult white male rats. The main group of animals was divided into three subgroups, on which bacteriological examination of parietal intestinal biotope and morphological examination of the small intestine on the first, third and seventh days of acute peritonitis on the background of concomitant diabetes were carried out. Diabetes mellitus was simulated by a single intraperitoneal injection of streptozotocin (60 mg / kg). On day 14 of diabetes mellitus, rats were injected with 0.5 ml of 10 % filtered fecal suspension into the abdominal cavity and acute generalized peritonitis was initiated. The control group consisted of rats (n=8), which were injected subcutaneously with saline 0.9 % NaCl. Results and discussion. Bacteriological examination of the parietal intestinal biotope and morphological examination of the small intestine were performed. In the first subgroup of animals with acute peritonitis on the background of streptozotocin-induced diabetes mellitus, the dominant microbiota isolated from the parietal intestinal habitat was represented by Escherichia coli (70 %), Candida spp. (20 %) and Staphylococcus spp. (20 %). A monoculture of microorganisms was identified in 40 % of animals. In the second subgroup, the number of microbial associations increased to 78 %. Three-component associations predominated in the third subgroup, dominated by Escherichia coli (57 %) and Enterobacter aerogenes (43 %). In the control group of animals Bifidibacterium spp., Lactobacillus spp., Escherichia coli, Staphylococcus spp were found. The progression of the inflammatory process on the background of hyperglycemia was accompanied by the increase in the number of Enterobacter aerogenes, Bacteroides spp, Candida spp. and by the decrease in the number of Escherichia coli. The results of morphological examination of the mucous membrane of the small intestine of rats at different stages of development of this combined pathology indicate the development of an active inflammatory reaction, which is the basis for the deterioration of absorption function and enteral insufficiency syndrome. Alterative changes manifested by uneven vacuolation of villi epithelial cells, areas of epithelial desquamation, as well as severe infiltration of the mucous membrane by neutrophilic granulocytes, monocytes and lymphocytes increased throughout the experiment and were most characteristic of animals of the third subgroup, mortality in which reached 38 %. Conclusions. The results of bacteriological examination of the parietal intestinal biotope of animals with acute peritonitis on the background of streptozotocin-induced diabetes mellitus indicate the dominance of Escherichia coli (65 %), Enterobacter aerogenes (23 %), Candida spp. (23 %), Bacteroides spp (19 %) among the representatives of the microbiota of the small intestine. The development of the inflammatory process of the peritoneum on the background of hyperglycemia is accompanied by a decrease in the height and thickness of the villi, crypt depth, dystrophic changes of mucosal cells, which indicates the decrease in the barrier function of the small intestine and is the cause of bacterial translocation, which is enhanced by qualitative and quantitative changes in microbes (predominance of associations of pathogens of aerobic gram-negative microorganisms and fungi of the genus Candida).

BACKGROUND:Acute generalized peritonitis (AGP) is a life-threatening condition that demands rapid diagnosis and treatment, especially in pediatric patients. However, limited literature is available regarding its epidemiological, clinical, and therapeutic aspects in under-served areas of Morocco, particularly in Southeast provinces. Therefore, this study aims to examine the epidemiological characteristics, clinical and paraclinical presentations, and management of acute generalized peritonitis (AGP) in children aged 0-15 years from 2017 to 2023 with a 2-year forecast.MATERIALS AND METHODS:This retrospective study included 115 patients with AGP. Data analysis was conducted using the Chi-square test. Furthermore, the Holt-Winters method was used to forecast the AGP cases from January 2024 to December 2025.RESULTS:The majority (71.30%) were aged 8-15 years, with a male predominance (65.22%). The most frequent clinical features included fever and abdominal pain (100%) and abdominal guarding (87.83%). Appendicular peritonitis was the most common intraoperative diagnosis (86.09%). Surgical interventions included drainage (100%) and appendectomy (96.52%), with 86.09% of surgeries performed within 24 h. Postoperative complications were rare (4.35%), with septic shock (3.48%) being the most severe. Furthermore, the Holt-Winters model predicts continued variability of trend and seasonality of AGP cases in the upcoming years.CONCLUSIONS:According to the results of this study, timely surgical management and effective antibiotic therapy were critical for positive outcomes. In addition, the prediction results showed a similar pattern to the actual data concluding that the proposed model can be used to forecast the future cases of AGP in this area.

Objective. The study aims to evaluate the severity of endogenous intoxication and characterize morpho-functional liver changes during experimental acute generalized peritonitis (AGP) in diabetic rats. Methods. Fifty-six adult male Wistar rats were used, including 8 controls and 48 males with experimental pathology. Diabetes mellitus was induced by an intraperitoneal (i.p.) injection of streptozotocin (60 mg/kg). On day 14, AGP was induced by i.p. injection of a 10% filtered fecal suspension. Endogenous intoxication was assessed by measuring hydrophilic and hydrophobic molecular products in the blood. Liver function was evaluated by serum aminotransferase activity, total protein, and protein fractions. Histological analysis of liver tissue was performed using standard hematoxylin-eosin staining. Results. A progressive increase in endogenous intoxication was observed peaking on day 7. This was marked by a significant elevation in middle molecular weight molecule (MMWM) concentrations at wavelengths of 254 nm and 280 nm by 103.0% (p<0.001) and 340.0% (p<0.001), respectively. The erythrocyte intoxication index (EII) increased by 148.8% (p<0.001) compared to controls. Concurrently, aminotransferase activity increased, while serum total protein and albumin levels decreased. Histologically, inflammatory infiltration and vascular congestion were evident on day 1 progressing to hepatocellular dystrophy and necrosis by day 3. By day 7, signs of hepatic failure were present including disruption of trabecular architecture, hydropic degeneration, intra-cellular cholestasis, and portal tract expansion due to vascular hyperemia. Conclusions. Experimental acute generalized peritonitis in diabetic rats resulted in a pronounced endogenous intoxication accompanied by progressive morpho-functional liver damage culminating in hepatic insufficiency by day 7.

Introduction: Acute generalized peritonitis is a life-threatening emergency. It is most often secondary to a perforation of the digestive organ and or to the spread of an intra-abdominal septic area. Methodology: We carried out a descriptive retrospective study lasting from January 1, 2018 to December 31, 2018 on the contribution of imaging in the management of acute generalized peritonitis general surgery department of the hospital Chinese-Guinean. Were included in our study, all records of patients with acute generalized peritonitis will be confirmed by imaging. We carried out an exhaustive recruitment of all complete files. Our variables were analyzed using the Epi-info 7.2 software. Result: Out of 578 hospitalized patients, peritonitis represented 8.8% of cases. We noted a male predominance with 60.8% and a Sex-ratio: M / F = 1.6 whose mean age was 41.9 ± 13.5 years; extremes ranging from 17 and 67 years with a modal class ≥ 30 years or 88.3%. Housewives were the most collected with 25.5% Abdominal pain was the main reason for consultation, i.e., 90.2%, the physical sign was dominated by a convex and sensitive Douglas-fir, i.e., 27.5%. The clinical diagnosis was supported by abdomen without preparation and abdominal ultrasound; performed in 84.3% and 15.7% of patients, respectively. We noted a morbidity rate of 15.7% dominated by septic shock (15.7%). Conclusion: Our study made it possible to determine the contribution of imaging in the management. In addition, in our study, the abdomen without preparation and the abdomino-pelvic ultrasound were revealed as a key link in the management of acute generalized peritonitis.

Our aim was to define the epidemiological profile of acute generalized peritonitis in N'Djamena, Chad. This retrospective study, conducted in the general surgery department of the National Reference General Hospital, examined the files of 492 patients who underwent surgery for acute generalized peritonitis from June 2007 to December 2012. Epidemiological, clinical, paraclinical, and therapeutic characteristics were described. Acute generalized peritonitis accounted for 35.2% of all visceral surgical emergencies. Male patients were at highest risk (sex-ratio 6.5). The patients' mean age was 25.8 years (range 1 to 70 years). All patients had abdominal pain. The leading cause was traumatic visceral perforation by stabbing or a firearm in 226 cases (46%), followed by diffuse appendiceal peritonitis. Primary peritonitis was rare. The principal procedure was surgical excision and suture. The mean time to consultation was 3 days and the mean hospital stay 8.5 days. The morbidity rate was 16.8%, dominated by wound infection. The mortality rate was 6.8%. Abdominal trauma is the major cause of acute generalized peritonitis in N'Djamena. Prognosis depends on time to surgical management.

In acute peritonitis, any surgical intervention leads to impaired immune protection with the development of postoperative purulent-septic complications, which increases several times the likelihood of death, especially in people with secondary immunodeficiency as a consequence diabetes mellitus.We aimed to study the dynamics of pro- and anti-inflammatory cytokine content in rat serum under experimental acute generalized peritonitis on the background of diabetes mellitus.Fifty-six white rats were used for the study. The determination of the serum cytokine profile was performed by enzyme-linked immunosorbent assay.When comparing the levels of interleukins between the study groups, a statistically significant increase in the level of proinflammatory cytokines was found in the group of diabetic animals during all experimental periods. In particular, the concentration of interleukin – 1β increased significantly by 94% on day 1 of observation, by 115% on day 3, and by 121% on day 7 compared to the control group. Similarly, a significant increase in TNF-α levels was observed in animals with diabetes. In this group, the most significant increase in the level of TNF-α was recorded on the seventh day of the experiment, and it increased by 3.4 times.Animals with acute peritonitis on the background of diabetes had a significantly increased concentration of anti-inflammatory cytokines in the serum of all study groups, which confirms their involvement in the pathogenesis of the disease under study.

Background Acute generalized peritonitis in resource-poor countries is still a health challenge due to late diagnosis, surgical delay, and specialists' unavailability. These are the foremost determinants of surgical morbidity and mortality. We report the experience of a peripheral hospital in Benin not equipped with specialized surgeons. Methods This is an observational, retrospective, and descriptive study including patients operated for acute generalized peritonitis at the Atacora Departmental Hospital Centre, Benin, where unfortunately CT scan and intensive care unit are still not available. Most of surgical activities were performed by a general practitioner with previous surgical training (but no surgical specialization). Age, gender, cause of peritonitis, surgical procedures, and postoperative outcome were evaluated. Results Sixty-three patients were included. The mean age was 23.2 years and sex ratio M/F 1.5. The mean surgical delay was 26 hours (range: 6–92 hours). An ileal typhoid perforation was found in 40 patients (63.5%), and 35 of them (87.5%) underwent a primary perforation repair without bowel resection. 73% of surgical procedures were performed by the general practitioner. Morbidity was 34.9% and mortality was 14.3%. The average postoperative hospital stay was 12 days (range: 11–82 days). These results were comparable to those observed in the subgroup of patients (17 cases) operated by the general surgeons (morbidity 32.6%, mortality 13.0%, and average postoperative hospital stay 11 days, range: 1–58 days). Conclusion Acute generalized peritonitis requires urgent management, and it can be effectively carried out, in a context of limited resources, by a general practitioner with surgical skills.

Introductionthe aim was to determine epidemiological, clinical, therapeutic, and prognostic aspects of acute generalized peritonitis (AGP).Methodswe conducted an observational, cross-sectional and multicentre study over 2 years of 278 cases of acute generalized peritonitis operated in semi-urban and urban hospitals in South-Kivu Province, Democratic Republic of Congo.Resultsthe population of this study was young with a mean age was 28.9 ± 16.1 years with extremes of 1.3 years to 80 years with a sex ratio M: F of 0.8. Peritonitis aetiology was dominated by intestinal perforation 132 cases (47.4%), the admission time in 65, 5% was more than 72 hours. Acute abdominal pain was the most reason for consultation in 93.2% of cases, 11.9% of patients were in hypovolemic shock. In 40.6%, the treatment of patients consisted in intestinal resection with terminal anastomosis, or ileostomy in 32.7%. About the outcomes, 32.4% of the patients had a surgical reoperation and 15.8% of the digestive fistulas were reported. The average duration of the hospitalization was 23.4 ± 20.3 days. Morbidity rate was 14.7%.Conclusionthe AGP remains one of the abdominal emergencies observed in different semi-urban and urban hospitals of the province of South-Kivu, causing some problems of medical and surgical management, starting from the delay of admission, the severity of the symptoms related to the etiology of the intestinal perforation. In all cases, AGP requires a well-executed resuscitation procedure and surgical technique to improve the prognosis and reduce mortality, which seems to be high in this study.

surgery is associated with lower morbidity and mortality. However, the laparoscopic approach to the management of peritonitis remains marginalized in low and middle-income countries (LMICs) due to financial and technical limitations.Methods: We conducted a seven-year prospective study on patients with acute generalized peritonitis in Yaounde, Cameroon. Inclusion criteria were an age range of between 5 to 55 years, admission within 48 hours after the onset of symptoms, hemodynamic stability, and no major comorbidities. Excluded from this study were patients with colonic perforation, prior history of abdominal surgery, or primary and localized peritonitis after proper resuscitation. The patients included were managed via laparoscopy; operative and postoperative data were collected and analyzed. Some technical artifices were used to circumvent the lack of standardequipment. Results: The study involved twenty-five patients with a mean age of 32.1 years. The etiology of peritonitis was identified as appendicitis in 20 cases, perforated duodenal ulcer in 2 cases, gastric ulcer perforation in 2 cases, and jejunal perforation in 1 case. In two cases (8%), the operation was onverted to laparotomy. The postoperative course was uneventful in 21 cases (84%), whereas morbidity was seen in 4 cases (16%); no mortality was recorded. The mean length of hospital stay was 5.5 days.Conclusions: This study demonstrates that the laparoscopic management of acute generalized peritonitis in African LMICs is afeasible, safe, and effective surgical option in properly selected patients.

Background: Generalized surgical acute abdomen is a significant cause of morbidity and mortality in the Nigerian environment. Severity assessment is useful in order to prioritize treatment and reduce morbidity and mortality. High severity scores are often faced with high morbidity and mortality; these patients, often require more intensive treatment than those with low severity scores. The purpose of this study was to assess the severity of generalized surgical acute abdomen in adult patients using the Acute Physiological and Chronic Ill Health Evaluation (APACHE II) score.Methods: All patients (184) aged 16 years and above, admitted and operated for generalized acute abdomen over a period of 6 years from January 1993 to December 1998 were prospectively studied. Demographic, clinical, preoperative, operative and postoperative data on each patient were entered into a prepared proforma. Severity of illness was assessed using APACHE II parameters. Postoperative outcome and severity of illness were compared to determine the significance of severity of illness on postoperative outcome.Results: Thirty‐one patients (17%) died and 78 (42.4%) developed other postoperative complications. The APACHE II scores significantly correlated with the mortality and such other postoperative complications as residual intra‐abdominal abscess, abdominal sepsis, chest infection and faecal fistula (P &lt; 0.05) and the duration of hospital stay (P &lt; 0.05). The APACHE II scores ranged from 0 to 18, the mean score for survivors was 5.7, while it was 12.3 for those who did not survive. Only three (4%) patients who scored 0–5 died, six (9.4%) patients who scored 6–10, 15 (50%) patients who scored 11–15 and seven patients (87.5%) died who scored 16–20.Conclusion: The study showed that the severity of generalized peritonitis can be suitably assessed by APACHE II score in our environment and may serve as means of objective assessment of the quality of care. APACHE II score predicted mortality and morbidity in the patients studied. A further study is needed involving a larger number of patients to further validate our findings. We recommend to surgeons practicing in an environment similar to ours and to use the APACHE II scoring system in the assessment of patients with acute generalized peritonitis.

In the pathogenesis of acute widespread peritonitis and accompanying diabetes, a vital link is an endogenous intoxication caused by the translocation of microorganisms and their toxins from the intestine into the blood, metabolic changes, and immunological reactivity of the body. Our work aimed to investigate the microbial composition in the parietal intestinal biotope and the features of the blood cytokine profile in animals with acute disseminated peritonitis on the background of streptozotocin-induced diabetes. The study was conducted on 56 sexually mature non-linear white male rats. Diabetes mellitus was modeled by a single intraperitoneal injection of streptozotocin (60 mg/kg). On the 14th day of the development of streptozotocin-induced diabetes mellitus, a 10% filtered fecal suspension (0.5 mL) was injected into the abdominal cavity of animals, and acute generalized peritonitis was initiated. Sowing on nutrient media was carried out for bacteriological research to isolate a pure culture of microorganisms and their identification. The concentration of TNF-α, IL-1β, and IL-6 was studied by solid-phase enzyme immunoassay. The research results demonstrate an imbalance of cytokines in the dynamics of experimental acute disseminated peritonitis against the background of diabetes and quantitative and qualitative changes in the microbiota of the parietal intestinal biotope. A decrease in the number of Escherichia coli strains isolated in monoculture and an increase in the number of two-component and three-component microbial associations were revealed, among which Enterobacter aerogenes, Escherichia coli, Bacteroides spp., Proteus mirabilis, Klebsiella spp. and Candida species prevailed.

The aim of our work was to make an inventory of the anesthesiological management of acute generalized peritonitis at the CHU-Kara. To determine the frequency of acute generalized peritonitis; to describe their treatment in pre, per and postoperative; to analyze the postoperative follow-up. This work was a retrospective descriptive study carried out on the files of patients operated for acute generalized peritonitis from November 1, 2019 to October 31, 2020. The study was performed in the surgical resuscitation department and in the operating room. Fifty-eight cases of generalized peritonitis were selected for the study. Peritonitis represented 27.8% of abdominal surgical emergencies. The patients were male dominated with a mean age of 29.6 years. The average consultation time was 3.5 days. Fever was the predominant clinical sign on admission (72.4%). The average duration of preoperative resuscitation was 17 hours and 18 minutes. The combination of Ceftriaxone and Metronidazole was the most used antibiotic therapy. General anesthesia was standard. Spinal anaesthesia was the second technique used. Preoxygenation was systematic for general anesthesia. Pancuronium (72.2%) was the most used curare. The average duration of anesthesia was 105 minutes. Laparotomy, peritoneal cleansing and drainage were performed in all patients, followed by excision-suture of the stomach (43.1%). Peritonitis due to peptic ulcer perforation predominated (43.1%) followed by typhoid perforation of the small intestine (24.1%). The morbidity rate was 41.4%, dominated by parietal suppurations (15.5%). The mortality rate was 8.6%. The average length of stay in intensive care was 8.7 days. The anesthesiological management of acute peritonitis remains a real challenge for anesthesiologists, given the major volume disturbances, the delay in diagnosis with its corollary of septic shock, and the lack of qualified personnel with which they are faced. Peritonitis is a real public health problem because of its still very high mortality. It was carried out with insufficiencies related to the poverty of the population, the inexistence of universal health insurance, the insufficiency of the technical platform and the insufficiency of organization.