Peritoneal Contents Research Articles

Intra-abdominal Hypertension

Intra-abdominal hypertension occurs in 50% of all patients admitted to the intensive care unit and is associated with significant morbidity and mortality. Intra-abdominal hypertension is defined as a sustained, pathologic rise in intra-abdominal pressure to 12 mm Hg or more. Patients with intra-abdominal hypertension may progress to abdominal compartment syndrome. Early identification and treatment of this condition will improve patient outcome. Patients at risk for intra-abdominal hypertension include those with major traumatic injury, major surgery, sepsis, burns, pancreatitis, ileus, and massive fluid resuscitation. Predisposing factors include decreased abdominal wall compliance, increased intraluminal contents, increased peritoneal cavity contents, and capillary leak/fluid resuscitation.

Intra-abdominal Hypertension

Intra-abdominal hypertension occurs in 50% of all patients admitted to the intensive care unit and is associated with significant morbidity and mortality. Intra-abdominal hypertension is defined as a sustained, pathologic rise in intra-abdominal pressure to 12 mm Hg or more. Patients with intra-abdominal hypertension may progress to abdominal compartment syndrome. Early identification and treatment of this condition will improve patient outcome. Patients at risk for intra-abdominal hypertension include those with major traumatic injury, major surgery, sepsis, burns, pancreatitis, ileus, and massive fluid resuscitation. Predisposing factors include decreased abdominal wall compliance, increased intraluminal contents, increased peritoneal cavity contents, and capillary leak/fluid resuscitation.

Reconstruction of an External Hemipelvectomy Defect with a Two-stage Fillet of Leg-Free Flap

The defect created by external hemipelvectomy for bone and soft tissue tumor resection is a challenge to reconstruct because of the exposure of bone, neurovascular structures, and peritoneal contents, particularly in the setting of previous radiotherapy. In a nonsalvageable limb with extensive tumor involvement and radiation damage, a free fillet of leg flap can be used to provide the necessary large volume of tissue for reconstruction without donor site morbidity. Because of the lengthy operative time for the hemipelvectomy procedure, the fillet of leg flap may be subject to long ischemia time and a subsequently compromised outcome. A two-stage fillet of leg flap for a hemipelvectomy defect was performed with two goals: to decrease ischemia time and to allow the necessary resuscitation of the patient between operative stages. Stage one was dissection of a lower fillet of leg flap, transfer and anastomosis to the contralateral femoral vessels, and temporary inset in the groin. The patient and flap were observed in the intensive care unit for several days. The patient returned to the operating room 3 days later for staged external hemipelvectomy and inset of the viable fillet of leg flap. Throughout follow-up, the reconstructive results and functional outcome were excellent.

Abdominal Compartment Syndrome as a Consequence of Rectus Sheath Hematoma

Abdominal compartment syndrome is a well-documented entity arising from multiple and various causes. The rise of intra-abdominal pressure by the increase in volume of the peritoneal and retroperitoneal contents has been shown in the resuscitation and evaluation of surgical patients. However, the incidence of constriction of the abdomen causing intra-abdominal hypertension is unknown. Previously limited to burn eschar and externally applied devices (such as MAST trousers), external compression leading to abdominal compartment syndrome has been a limited entity. We report the first documented case of an expansive abdominal wall mass, a rectus sheath hematoma, leading to impending abdominal compartment syndrome.

Rectus Femoris Myocutaneous Flap for Vulvoperineal Reconstruction

Background. Many reconstructive procedures for large vulvoperineal defects have been described. The present report describes the use of the rectus femoris myocutaneous flap, which has not previously been described for this purpose.Case. A 52-year-old woman suffered a local recurrence of a Bartholin's gland carcinoma after anterior exenteration and pubectomy. A palliative resection was performed which resulted in a large vulvoperineal defect with transpelvic herniation of the peritoneal contents. This was immediately reconstructed with a rectus femoris myocutaneous flap. Her postoperative course and healing were uneventful.Conclusion. This technique is an alternative method for vulvar reconstruction. It is especially useful for large defects when a gracilis or rectus abdominis flap is not available.

General anaesthesia for emergency surgery during acute organophosphate poisoning

General anaesthesia for emergency surgery during acute organophosphate poisoning

Effects of methylene blue, indigo carmine solution and autologous erythrocyte suspension on formation of adhesions after injection into rats

The aim of this study was to determine whether autologous erythrocyte suspension can be used as a dye for evaluation of tubal patency and whether it has any advantages over methylene blue or indigo carmine solutions. Reproductively healthy female nulliparous Wistar Albino rats (n = 30), aged 6 months, mass 165-195 g, were assigned randomly to three groups. Rats received a 1 ml i.p. injection of 5% (w/v) methylene blue solution (methylene blue group: n = 10), 5% (w/v) indigo carmine solution (indigo carmine group: n = 10) or 5% (v/v) fresh autologous erythrocyte suspension (autologous erythrocyte group: n = 10). At 4 weeks after injection, a small sterile opening was made in the peritoneal cavity of each rat. The cavity was rinsed once with TCM-199 to collect macrophages. The rinsed peritoneal contents were cultured overnight to evaluate macrophage activation. The peritoneal opening was expanded for evaluation of adhesion formation. Only one rat from the autologous erythrocyte group had intra-peritoneal adhesions (score 2), whereas all rats in the methylene blue group (score 1: n = 1; score 2: n = 4; score 3: n = 4; and score 4: n = 1) and seven rats in the indigo carmine group (score 1: n = 1; score 2: n = 2; score 3: n = 3; and score 4: n = 1) had intra-abdominal adhesions. Macrophage activity was observed in the cultured peritoneal contents collected from the methylene blue and indigo carmine groups but not from the autologous erythrocyte group. Adhesion formation could be due to macrophage activation caused by methylene blue and indigo carmine solutions. These results indicate that tubal patency can be observed by laparoscopy using autologous erythrocyte suspension. The results of this study are believed to be the first to indicate that a patient's own erythrocyte suspension could be used during observation of tubal patency by laparoscopy. However, further studies are required.

In vivo real-time analysis of intraperitoneal radiolabeled tumor cell movement during laparoscopy.

A porcine model has been developed to allow the real-time imaging of radiolabeled tumor cell movement throughout the peritoneal cavity, both at rest and during carbon dioxide insufflation. Fifteen 30-kg domestic white female pigs were used. Under anesthesia, 15 to 20 million radiolabeled human colorectal tumor cells (LIM1215) were introduced into the peritoneal cavity under laparoscopic vision into the pelvis. Radiolabeled tumor cell movement was examined by using a 25-cm-diameter, low-energy mobile gamma camera with high resolution collimator. Tumor cell movement and distribution during two hours without insufflation was examined in four pigs. Then tumor cell movement and distribution during two hours with CO2 insufflation was examined in four pigs. In a further four pigs, tumor cells were then mixed with blood and injected into the peritoneal cavity and the effect of no insufflation vs. insufflation was noted. A further three pigs were examined with manipulation of the intra-abdominal contents after injection of LIM1215 cells into the peritoneal cavity. Venting insufflating CO2 was filtered for tumor cells. Widespread intraperitoneal distribution of tumor cells from the pelvis was identified both with CO2 insufflation of the peritoneal cavity and without insufflation. Tumor cells dispersed throughout the peritoneal cavity at a slower rate without carbon dioxide insufflation. There was a differential rate of tumor cell movement to the left upper quadrant and right upper quadrant with insufflation and without insufflation. Blood within the peritoneal cavity and an extended contact of the laparoscopic trocars with the peritoneal cavity in this setting increased contamination of the trocars and trocar sites with tumor cells. Tumor cells were identified on laparoscopic instruments in all experiments. No evidence of aerosolization of tumor cells was found. Tumor cells move throughout the peritoneal cavity both at rest and during CO2 insufflation. The pattern of tumor cell dispersion differs with CO2 insufflation. The presence of blood and extended contact of trocars with peritoneal contents are a major factor in trocar and trocar site tumor cell contamination.

Experimental pyeloureterectomy and calyceal neck transection with autotransplantation and bladder advancement

To determine whether Dexon mesh, closely applied to the kidney, provides purchase for sutures to permit bladder/parenchymal apposition on autotransplantation and that, if this line of apposition were some distance from but surrounding renal papillae, urothelium would proliferate to cover exposed parenchyma to form a widely patent lumen; this should facilitate removal of the whole of an upper tract collecting system, retaining renal parenchyma alone. To test this possibility and explore the practicability of the concept, nine dogs underwent bilateral nephrectomy followed by unilateral autotransplantation: the other kidney was discarded. Because the canine renal pelvis is intrarenal, the ureter was stretched maximally before passing fine scissors into the renal hilum to transect the collecting system as close to the kidney as possible in six of the nine dogs. In the remaining three dogs, partial nephrectomy was performed with division of the calyceal necks under vision. Thinned bladder wall was sutured to Dexon mesh some distance from the collecting tubules; omentum was applied to the suture line. Three dogs were killed prematurely at < 2 weeks because of perioperative complications. Four were killed at 2, 4, 5 and 8 weeks and two at 12 months. Dexon mesh proved to be an effective anchoring fabric, providing close apposition of bladder wall and parenchyma. There was no adhesion of the kidney to peritoneal contents. Urothelial proliferation to cover exposed parenchyma occurred early and by 12 months, a thin stroma was interposed between parenchyma and epithelium. The kidney was preserved in all but one removed electively, this dog having both cystitis and pyelonephritis at 12 months. This study showed that autotransplantation of a kidney after removal of its collecting system and advancement of thinned bladder wall to renal parenchyma is practicable, with regenerated urothelium bridging the deficiency by covering exposed parenchyma, to create a widely patent lumen.

Laparoscopic Extraperitoneal Herniorrhaphy

Laparoscopic extraperitoneal (LEP) herniorrhaphy procedures allow direct visualization and repair of many types of hernias (e.g., direct, indirect, femoral, sliding, bilateral). Common complications of open herniorrhaphy procedures are avoided when LEP herniorrhaphy procedures are used because the peritoneum is not entered. The placement of synthetic mesh in the preperitoneal space during LEP herniorrhaphy procedures prevents inadvertent contact with peritoneal contents and minimizes patients' risks of adhesions, bowel obstructions, fistulas, and intraabdominal vascular injuries. Improved anatomic presentation and optimal patient outcomes are achieved with this approach.

Pharmacological evaluation of leukotriene biosynthesis and inflammation in an adoptive model of peritoneal anaphylaxis in the mouse

AbstractThe ability of IgE anti‐arsenilate hapten‐sensitized bone marrow‐derived mast cell line (1BD‐8) to generate leukotriene C4 (LTC4) and increase vascular permeability, and neutrophil infiltration in vivo in Balb/c mice challenged with arsenilated BSA (ARS‐BSA) was studied. Sensitized 1BD8 cells (5‐10 × 106) were administered intraperitoneally followed by 0.1 μg ARS‐BSA. Following CO2 asphyxia, the peritoneal contents were harvested and assayed for immunoreactive LTC4 (iLTC4) by radioimmunoassay. Maximal production of iLTC4 (60 ng/mouse) was seen 2.5 min after challenge and then decreased to a nadir at 15 min. Animals which were depleted of resident peritoneal cells by treatment with cyclophosphamide gave an iLTC4 response equivalent to non‐treated controls, indicating that the transferred cells contributed most of the iLTC4 response. The oral administration of the 5‐lipoxygenase (5‐LO) inhibitors, phenidone, SK&amp;F 107649, and the pyridinyl imidazoles SK&amp;F 104493 and SK&amp;F 105809 all reduced the iLTC4 response (61‐96% inhibition); whereas the vasoactive amine antagonist cyproheptadine and the cyclooxygenase inhibitors, meclofenamic acid and naproxen, had no effect. Extravasation of Evans blue dye was also monitored spectrophotometrically and was significant 5 min after challenge and reached a plateau at 45 min. Like iLTC4, despite depletion of resident peritoneal cells, no difference in dye extravasation was seen in cyclophosphamide‐ versus saline‐treated animals. Those compounds which inhibited iLTC4 also inhibited dye extravasation with similar potency. Cyproheptadine, however modestly, inhibited dye extravasation (33%) without altering iLTC4 production. Neutrophil infiltration was also monitored and was significantly inhibited by the oral administration of phenidone (73%) and SK&amp;F 104493 (81%). This model provides a reliable method to evaluate in vivo inhibition of leukotriene biosynthesis and the associated inflammatory response induced by a pathophysiologically relevant stimulus. © 1993 wiley‐Liss, Inc.

Tfe-Plasma Polymerized Dermal Sheep Collagen for the Repair of Abdominal Wall Defects

The aim of this study was to design and evaluate a degradable biomaterial for the repair of abdominal wall defects. Hexamethylenediisocyanate-tanned dermal sheep collagen (HDSC) was plasma-polymerized with tetrafluoroethylene (TFE) which resulted in a hydrophobic surface on the visceral side (TFE-HDSC). Full-thickness abdominal wall defects were made in rats and repaired with HDSC or TFE-HDSC implants. Unmodified HDSC implants showed excellent fixation to the adjacent muscle tissue but intestinal adhesions were observed. These implants showed insufficient strength after four weeks, illustrated by bulging of the peritoneal contents (herniation). Plasma-polymerized implants after four weeks of implantation showed firm incorporation into the surrounding muscle tissue. With one exception there were no bowel adhesions. Fewer herniations were observed, indicating a prolonged degradation period. Further studies on the optimalization of degradation time are in progress.

The Bacteriology of Gangrenous and Perforated Appendicitis—Revisited

By using optimum sampling, transport, and culture techniques in patients with gangrenous or perforated appendicitis, we recovered than has previously been reported. Thirty patients older than 12 years with histologically documented gangrenous or perforated appendicitis had peritoneal fluid, appendiceal tissue, and abscess contents (if present) cultured. Appendiceal tissue was obtained so as to exclude the lumen. A total of 223 anaerobes and 82 aerobic or faculatative bacteria were recovered, an average of 10.2 different organisms per specimen. Twenty-one different genera and more than 40 species were encountered. Bacteroides fragilis group and Escherichia coli were isolated from almost all specimens. Within the B. fragilis group, eight species were represented. Other frequent isolates included Peptostreptococcus (80%), Pseudomonas (40% [P. aeruginosa, 23.3%, other Pseudomonas spp., 16.7%]), B. splanchnicus (40%), B. intermedius (36.7%), and Lactobacillus (36.7%). Interestingly a previously undescribed fastidious gram-negative anaerobic bacillus was isolated from nearly one half of all patients. This organism was found to have low DNA homology (by dot blot) with the known organisms most closely resembling it.

Fibrinogen Derivatives in Particle Aggregation by Peritoneal Contents

Fibrinogen Derivatives in Particle Aggregation by Peritoneal Contents

Fibrinogen derivatives in particle aggregation by peritoneal contents

Summary Supernatants of peritoneal washings of normal mice and solutions of human or murine fibrinogen aggregated carbon in indian ink, colloidal saccharated iron oxide and suspensions of polystyrene latex, but did not clump thorotrast or colloidal gold. In peritoneal washings allowed to stand, the ability to aggregate tended to appear and then disappear; solutions of purified fibrinogen became active after dilution and standing. Fibrinolytic digestion of carbon clumped by mouse peritoneal supernatants or by fibrinogen, released soluble products possessing the serological specificity of fibrinogen. Early fibrinogen degradation products are thought to be the agents in peritoneal washings causing aggregation of the particles.

The correlation between plasma cell tumor development and antibody response in inbred strains of mice.

SummaryThe antibody response to bovine serum albumin and the development of hyperglobulinemia following administration of intraperitoneal mineral oil separated BALB/c and A-mice from DBA, C57B1, and C3H mice. BALB/c mice developed many plasma cell tumors following intraperitoneal mineral oil injections. The A-mice developed 1/10 tumors but the peritoneal contents showed extensive phagocytosis of tumor cells. This phenomenon is observed in BALB/c mice only when tumor development is inhibited by administration of glycoprotein pituitary hormones. A hypothesis is developed to explain these observations.

Particle aggregation by peritoneal contents

Peritoneal washings from normal mice, or the cell-free Supernatants, and fibrinogen preparations of human and murine origin were alike in their ability to aggregate carbon in indian ink, polystyrene latex, colloidal metal oxides, and solutions of certain dyes.Peritoneal fluid tended first to develop and then to lose the power to aggregate suitable materials on standing at room temperature; fibrinolytic digestion of carbon aggregated by peritoneal fluid or by fibrinogen released products with the serological specificity of fibrinogen. Intermediate products in the degradation of fibrinogen appeared to be the aggregating factor in mouse peritoneal fluid in vitro .

The physics of the abdominal cavity and the problem of peritoneal drainage

Draining of the peritoneal cavity is governed by physical laws. The mean pressure in the subhepatic area is subatmospheric and neutral or near zero in the subumbilical regions. The peritoneum therefore resembles an infusion bottle. To obtain an outflow of peritoneal fluid contents, an air vent must be added to the tube destined to drain the peritoneal cavity. A Chaffin double tube which maintains a positive pressure within the peritoneal space while emptying the fluid by slow suction is a most suitable aid for a working abdominal drainage in which gravity drainage cannot be used.