Loss of colonic structural collagen impairs healing during intra-abdominal sepsis
G. M. Ahrendt, K. Gardner and A. Barbul
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
OBJECTIVE: To investigate colon anastomotic healing in an experimental
model of sepsis. DESIGN: Prospective, randomized, experimental trial.
SETTING: Experimental surgical laboratory of a large community hospital.
STUDY PARTICIPANTS: Twenty-eight male Sprague-Dawley rats weighing 310 to
380 g. INTERVENTIONS: On day 0, the rats underwent either sham laparotomy
or cecal ligation and puncture. The next day, the rats underwent left colon
resection and single-layer inverted anastomosis. Colon-bursting pressure
was determined 5 days after surgery at which time the anastomosis and a
segment of colon 3 cm proximal to the anastomosis were excised. MAIN
OUTCOME MEASURES: Colon-bursting pressure, colonic hydroxyproline
concentration (index of collagen content), and total protein concentration
measured as alpha-amino nitrogen. RESULTS: Sepsis resulted in decreased
anastomotic bursting pressure and collagen concentration in all colon
segments that were analyzed in the animals that underwent cecal ligation
and puncture compared with control animals. CONCLUSIONS: Sepsis impairs
healing of the colon, reflected by decreased bursting pressure and collagen
concentration. The decrease in bowel wall structural collagen may affect
the ability of the gut to hold sutures and thus may lead to more
anastomotic failure.
