Whole gut washout ameliorates the progression of acute experimental pancreatitis

BACKGROUND: Septic complications are mainly responsible for deterioration o f a patient with acute pancreatitis. Intestinal tract is accepted as the ma in source of pancreatic or peripancreatic infection. MATERIAL AND METHODS: Acute pancreatitis was induced in 40 Sprague-Dawley r ats by ligation of the main biliopancreatic duct. Animals were divided into two groups. The first group of animals (n = 20) received high volume polye thylene glycol-3500 (GoLYTELY) for 6 hours through a silastic catheter intr oduced into the proximal part of the jejunum from a puncture gastrostomy du ring the initial laparotomy. The second group animals (n = 20) did not rece ive any treatment. Half of the animals from each group were sacrificed 72 h ours later and tissue samples were taken from mesenteric lymph nodes, pancr eas, spleen, and liver for bacteriologic cultures. Cecum cultures were also prepared. Blood samples at 72 hours were obtained for the measurement of a mylase, lactic dehydrogenase (LDH), lactic acid, alanine aminotransferase ( ALT), glucose, calcium, arterial pH, base excess, partial oxygen pressure, bicarbonate, leucocyte count, and hematocrit levels. The pancreas was exami ned histopathologically. The remaining half of the animals from each group were allowed to survive until death. RESULTS: The levels of amylase, LDH, ALT, lactic acid, pH, pO(2), bicarbona te and base excess for the rats in group I were significantly lower when co mpared with the rats in group II (P <0.05). Positive mesenteric lymph node cultures were detected in 30% of group I animals whereas they were positive in 90% of group II animals (P = 0.0198). Distant organ cultures were posit ive in 8 animals (liver 5, spleen 2, pancreas 1) in group II, whereas only one positive distant organ culture (liver) was established in group I (P >0 .05). Histopathological scoring observed in the pancreas were less severe f or the rats in group I when compared with the rats in group II (P = 0.012). The rats in group I survived longer than the rats in group II (median surv ival 6.8 days versus 17.3 days, P <0.001). CONCLUSIONS: Whole gut washout with high-volume polyethylene glycol in panc reatitis reduced the blood levels of enzymes and increased the survival. Wh ole gut washout for acute pancreatitis appears effective to ameliorate the prognostic factors in blood and this modality may be a promising treatment method in acute pancreatitis. Am J Surg. 2000;180:121-125. (C) 2000 by Exce rpta Medica, inc.