SYSTEMIC SPREAD OF INTRAABDOMINAL INFECTION VIA TRANSDIAPHRAGMATIC LYMPHATICS: EVALUATION WITH SERUM ENDOTOXIN AND CYTOKINE LEVEL IN RATS

Systemic spread intraabdominal infection is a common life-threatening condition in surgical practice. In the present study we investigated the role of lymphatic system in the occurrence of septic response during experimental peritonitis. The study was carried out on 30 rats equally separated into three groups. Group 1, sham laparotomy. Group 2, peritonitis was induced with cecal puncture. Group 3, a sheet of synthetic material was placed on the abdominal surface of the diaphragm in order to occlude lymphatic openings by a fibrous reaction. After six weeks peritonitis was created as in previous group. Samples were collected six hours after caecal puncture for: histopatological examination, microbiological analysis of peritoneal fluid and blood, and measurements of plasma endotoxin and serum tumor necrosis factor (TNF) levels. Bacterial peritonitis was present in all 20 animals of groups 2 and 3. Results of blood cultures were positive in 7/10 rats of group 2 and in 2/10 rats of group 3 (p=0.035). Mean plasma endotoxin levels were 8.3 and 1.8 EU/ml, and mean serum TNF levels 432 and 129 pg/ml in groups 2 and 3 respectively (p < 0.00 1). The occlusion of lymphatic openings on the abdominal surface of the diaphragm has significantly reduced the intensity of septic response during experimental peritonitis. We concluded that bacteria and endotoxin have promptly disseminated from the peritoneal cavity through lymphatic channels, and induced severe septic response in the early period of intraabdominal infection. The lymphatic system has a major role in systemic spread of intraabdominal infection.

KARINÝÇÝ ÝNFEKSÝYONUN DÝYAFRAGMA LENFATÝKLERÝ YOLUYLA SÝSTEMÝK YAYILIMI: RATLARDA SERUM ENDOTOKSÝN VE SÝTOKÝN SEVÝYELERÝYLE DEÐERLENDÝRME.

Karýniçi infeksiyonun sistemik yayýlýmý, cerrahi pratiðinde sýk görülen ve hayatý tehdit eden bir durumdur. Bu çalýþmada, deneysel peritonit esnasýndaki septik cevap oluþumunda lenfatik sistemin rolünü araþtýrdýk. Çalýþma eþit olarak üç gruba ayrýlan 30 rat üzerinde gerçekleþtirildi. Grup1, "sham" laparotomi. Grup 2, çekum delinmesiyle peritonit oluþturuldu. Grup 3, lenfatik aðýzlarýný fibrotik reaksiyonla týkamak için bir tabaka sentetik materyal diyafragmanýn abdominal yüzeyine yerleþtirildi. Altý hafta sonra önceki gruptaki gibi peritonit oluþturuldu. Çekum delinmesinden altý saat sonra, histopatolojik inceleme, periton sývýsý ve kanýn mikrobiyolojik analizi, ve plasma endotoksin ve serum tümör nekroz faktörü (TNF) ölçümleri için örnekler toplandý. Bakteriyel peritonit grup 2 ve 3'teki tüm 20 sýçanda mevcuttu. Kan kültür sonuçlarý 2. gruptaki 7,3. gruptaki 2 sýçanda pozitif idi (p=0.035). Sýrasýyla grup 2 ve 3'teki plasma endotoksin seviyeleri 8.3 ve 1.8 EU/ml (p < 0.001), serum TNF seviyeleri 432 ve 129 pg/ml (p<0.001) ölçüldü. Diyafragma abdominal yüzeyindeki lenfatik aðýzlarýnýn týkanmasý, deneysel peritonit esnasýndaki septik cevap þiddetini anlamlý olarak düþürdü. Sonuç olarak, bakteriler ve endotoksin periton boþluðundan organizmaya lenfatik kanallarla hýzla yayýlmakta, ve karýniçi infeksiyonun erken döneminde ciddi septik cevabý uyarmaktadýr. Karýniçi infeksiyonun sistemik yay ýlýmýnda lenfatik sistemin majör rolü vardýr.