EFFECT OF A PNEUMOPERITONEUM ON THE EXTENT AND SEVERITY OF PERITONITIS INDUCED BY GASTRIC-ULCER PERFORATION IN THE RAT

Laparoscopic surgical repair of perforated gastroduodenal ulcer is tec hnically feasible. To study the effect of a pneumoperitoneum on the ex tent and severity of peritonitis this animal study was devised. In rat s gastric ulceration was induced by instillation of ethanol (50%, 2 ml ) and followed by gastrotomy to simulate perforation. Animals were ran domly allocated to pneumoperitoneum (PP) and control groups. In PP gro ups CO2 was insufflated intraperitoneally 6, 9, 12, and 24 h after gas trotomy. In controls the abdomen was only punctured. Animals were sacr ificed 5 h after the end of PP or abdominal puncture. Blood cultures a nd intraabdominal swabs were assessed. A peritonitis severity score (P SS) based on histologies from peritoneum, liver, left kidney, spleen, and first jejunal loop was estimated. Six and 9 h after gastrotomy no significant differences between the PP and control groups were observe d; 12 h after gastrotomy cultures of blood samples and abdominal swabs were positive in 67% and 75% in the PP group compared to 42% (P < 0.0 5), and 42% (P < 0.05) in controls. The mean PSS was 20.8 (standard de viation [SD] 2.2) in the PP group compared to 11.3 (1.5) (P < 0.01) in controls; 24 h after gastrotomy cultures of blood samples and abdomin al swabs were positive in 83% and 100% in the PP group compared to 42% (P < 0.05) and 50% (P < 0.01) in controls. The mean PSS was 22.1 (1.5 ) in the PP group compared to 11.8 (2.4) (P < 0.01) in the controls. I n rats a pneumoperitoneum aggravates the extent and severity of perito nitis, when the interval between gastric ulcer perforation and pneumop eritoneum lasts 12 h or longer.