The influence of caecostomy 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 10,000 units of trypsin; the duodenum and common bile duct were occluded for three minutes. The control group (n = 36) had no further procedure, but the remaining rats were randomised to have either caecostomy (n = 40) or colonic irrigation (n = 36).

MAIN OUTCOME MEASURES

Mortality, histological grading of the pancreatitis, white cell count, serum amylase activity, and haemoglobin and 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 assessment. Later mortality was 23% (n = 7), 17% (n = 6), and 9% (n = 3), respectively. The control group had a significantly higher median endotoxin 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 amount 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 on the outcome of necrotising pancreatitis in rats.