The effect of tetracycline lavage and trauma on visceral and parietal peritoneal ultrastructure and adhesion formation.

The clinical efficacy of tetracycline lavage (1 mg/ml) in the management of abdominal sepsis has led to advocacy of its use in potentially contaminated cases. Yet at higher concentrations (6 mg/ml), tetracycline is a pleural sclerosant. The possibility of early ultrastructural peritoneal damage and later adhesion formation has been examined in syngeneic female Wag rats. At high concentration (10 mg/ml), tetracycline caused adhesions in the absence of peritoneal trauma and there was an associated loss of serosal microvilli. Lavage with low concentration tetracycline (1 mg/ml) or saline after clean abdominal surgery led to more adhesions than if no lavage was employed. There was an unexplained paradoxically low incidence of adhesions if prior mild contamination of the peritoneal cavity with 1 ml 10(5) E. coli had been performed.