Early metabolic and inflammatory intraperitoneal changes after rectum perforation.

Oikonomakis, Ioannis; Horer, Tal Martin; Skoog, Per; Nilsson, Kristofer; Jansson, Kjell Sigvard

Background and Aims Anastomotic leakage (AL) is the most dreaded complication in rectal surgery. It has a great impact on postoperative morbidity and mortality. This animal model, in which we have studied postoperative metabolic and inflammatory changes, is designed to imitate an anastomotic leakage. Materials and Methods 12 pigs were randomized into two groups. In the experimental group an iatrogenic rectal perforation was performed, the control group having a sham operation. The two groups were followed for 10 hours after operation with regard to vital parameters, arterial lactate, and cytokines IL1, IL6 and IL10 in the blood and intraperitoneally. Intraperitoneal microdialysis analyses of glucose, lactate, glycerol and pyruvate were performed and the lactate/pyruvate ratio was calculated. Results Glucose levels were lower in the experimental group after 4 hours. After 7 hours lactate and lactate/pyruvate ratios were higher in the experimental group. At the same time intraperitoneal cytokines IL6 and IL10 were higher in the experimental group.Blood samples showed higher IL6 after 7 hours in the experimental group. Conclusion In this study several significant differences between the groups in metabolic and inflammatory values were detected. Further clinical studies are recommended to evaluate the importance of intraperitoneal metabolic and inflammatory analyses as a diagnostic tool for early identification of an anastomotic leakage.