Role of mast cells in peritoneal adhesion formation.

Postoperative adhesions are a major cause of bowel obstruction and infertility. Since mast cells in the intestinal wall have been shown to degranulate after bowel manipulation, we investigated a possible role for these cells in peritoneal adhesion formation. Adhesions were created in weanling rats using cecal scraping and the application of 95% ethanol. The rats were treated with saline or one of two mast cell stabilizers, disodium cromoglycate (DSCG) or nedocromil sodium (NED), intraperitoneally 30 minutes before laparotomy and at the time of abdominal closure. The adhesions were assessed blindly 1 week later using a standardized scale. When the results in rats treated with DSCG were compared with those in rats treated with saline, the DSCG rats had significant attenuation of adhesion formation at 2 mg/kg (1.05 +/- 1.0 versus 2.15 +/- 0.8) and 10 mg/kg (1.2 +/- 0.9 versus 2.71 +/- 0.5). The application of NED decreased adhesions at a dose of 100 mg/kg (1.33 +/- 1.2 versus 2.4 +/- 0.8) but not at 10 mg/kg (2.4 +/- 0.8 versus 2.4 +/- 0.8). Histologic analysis using toluidine blue staining was done to assess the effect of DSCG on mast cell degranulation in the same adhesion model. DSCG significantly decreased the number of degranulated mast cells in the bowel wall when compared with saline (7.16 +/- 0.6 mast cells/high-power field [hpf] versus 12.4 +/- 1.9 mast cells/hpf). These data suggest that mast cells play an important role in the initial stages of peritoneal adhesion formation. In the future, pharmacologic inhibition of mast cell degranulation may be a useful adjunct for the prevention of postoperative adhesions.