Method for prediction of enteral insufficiency in acute peritonitis

• Elena E. Chepurnykh
• Shurygina I.А.
• Shurygin M.G.
• Dremina N.N.
• Trukhan I.S.

Abstract

Enteral insufficiency has a great impact on the course of acute peritonitis; the outcome of the disease depends on timely diagnosis and treatment of enteral insufficiency.

Aim – to develop a method for predicting enteral insufficiency in acute peritonitis.

Material and methods. The study was conducted in 18 Wistar male rats aged 6 months, weighing 250–300 g. The animals were simulated postoperative diffuse peritonitis according to the method we developed. Animals were sacrificed on days 3, 7 and 14 after the surgery, and a pathological examination of the intestine was performed.

The intraoperative material of 18 intestinal tissue samples from patients with acute surgical diseases of the abdominal cavity and with the presence of enteral insufficiency was studied. At the same time, histological sections were stained by the immunomorphological method using primary antibodies to Oxphos Complex IV subunit I. The result was assessed by the presence of enterocyte staining.

Results. It was found that in experimental animals, the severity of mucosal damage, which is the morphological equivalent of enteral insufficiency, increased with a maximum by day 14. When histological sections were stained using immunomorphological method on days 3 and 7, the staining of enterocytes for Oxphos was preserved. With an increase in enteral insufficiency (day 14), the staining for Oxphos in enterocytes was not detected, which indicated the depletion of the intestinal wall reparative abilities and an unfavorable prognosis. In the study of 18 intestinal tissue samples from patients with acute surgical diseases of the abdominal cavity and with the presence of enteral insufficiency, it was found that the presence of enterocyte staining in the samples fully corresponded to a favorable prognosis for enteral insufficiency outcome. The absence of enterocyte staining in the samples also fully corresponded to the unfavorable prognosis. The forecast accuracy was 100%.

Conclusion. The developed method for predicting enteral insufficiency in acute peritonitis makes it possible to determine the further course of enteral insufficiency in postoperative diffuse peritonitis. The specificity of the method is 100%, which is confirmed by the conducted pathological studies.

Keywords:peritonitis; prognosis; enteral insufficiency; Oxphos

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