THE INFLUENCE OF CECOSTOMY AND COLONIC IRRIGATION ON PATHOPHYSIOLOGY AND PROGNOSIS IN ACUTE EXPERIMENTAL PANCREATITIS

Objective: To find out if the presence of a stoma had any influence on the pathophysiology or prognosis of necrotising pancreatitis in rats. Design: Randomised controlled study. Material: 112 male Wistar rats. Interventions: Induction of pancreatitis by intraduodenal injection of 2 ml sodium taurocholate 2% with 10000 units of trypsin; the duodenum and common bile duct were occluded for three minutes. The control gro up (n = 36) had no further procedure, but the remaining rats were rand omised to have either caecostomy (n = 40) or colonic irrigation (n = 3 6). Main outcome measures: Mortality, histological grading of the panc reatitis, white cell count, serum amylase activity, and haemoglobin an d endotoxin concentrations in blood. Results: Operative mortality was 14% (n = 5) in the control group, 10% (n = 4) in the caecostomy group, and 8% (n = 3) in the irrigation group, leaving 31, 36, and 33 for as sessment. Later mortality was 23% (n = 7), 17% (n = 6), and 9% (n = 3) , respectively. The control group had a significantly higher median en dotoxin concentration (219 ng/l) than both the caecostomy group (79.2 ng/l, p < 0.05) and the irrigation group (71.7 ng/l, p < 0.05). The am ount of endotoxin was mirrored by the changes in the colonic mucosa in the different groups. Conclusion: Our results support the hypothesis that both caecostomy and colonic irrigation have a favourable effect o n the outcome of necrotising pancreatitis in rats.