THE PHYSICAL NATURE OF A LARGE-BOWEL PERFORATION PREDICTS SEVERITY OFTHE SUBSEQUENT INFLAMMATORY RESPONSE

The aim of the study was to determine how the physical nature of a lar ge bowel perforation influences the host inflammatory response. Two ra t 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 strong ly compartmentalized in the peritoneal cavity. Despite a sustained enh ancement of cytokines in peritoneal fluid, only a temporary burst of t umor necrosis factor, and no release of IL-1, were seen in serum, wher eas IL-6 was continuously released. Depletion of leukocytes was more p ronounced in CP than CLP. In summary, a large bower perforation like C P triggers an overwhelming host reaction with leukocytopenia, cytokine release, dehydration, hypoperfusion, and death. The smaller fecal ino culum in CLP gives a more subacute inflammatory response.