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.