Effect of aerosolized fibrin solution on intraperitoneal contamination
T. Dubrow, R. J. Schwartz, J. McKissock and S. E. Wilson
Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509.
The potential deleterious effects of aerosolized fibrin on contaminated
procedures were investigated in a rat model of peritonitis. One hundred
forty rats were divided into two groups. In the control group, gelatin
capsules containing feces (10(7) bacteria per milliliter) and barium
sulfate at various dilutions were placed into the abdomen; in the second
experimental group, a solution of cryoprecipitate, thrombin, and calcium
was sprayed diffusely into the peritoneal cavity after similar fecal
contamination. Fecal inocula with low bacterial concentrations (0.01, 0.1,
and 0.15 mL) caused few deaths from peritonitis or abscess formation in
either group. Heavy peritoneal contamination (0.25, 0.3, and 0.5 mL) caused
early deaths from peritonitis in both groups, with 80% of the deaths due to
sepsis in the first 48 hours. However, in the moderately contaminated rats
(0.2 mL of fecal inoculate), fibrin aerosol reduced the 10-day mortality
from 80% to 10%. In all survivors in the fibrin-treated group,
intraperitoneal abscesses developed. With intraperitoneal bacterial
concentrations of 2 x 10(6) organisms, early acute mortality from
fibrinopurulent peritonitis is decreased at the expense of late, localized,
nonlethal abscess formation. Aerosolized fibrin solution must be used with
caution in contaminated surgery.
