Influence of hemoperitoneum in spleen injury on the formation of peritoneal adhesions in intact peritoneum

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Abstract

Background. It is assumed that the outflow of blood during a spleen injury can cause an adhesive process, which justifies the need for sanitation of the abdominal cavity.

Aim. Determine the effect of hemoperitoneum on the formation of adhesions in an intact peritoneum.

Material and methods. The clinical part of the study included 82 patients with closed splenic injury observed from 2002 to 2019. The mean age was 11.1±3.5 years. There were 62 boys and 20 girls. The volume of hemoperitoneum was determined by ultrasound scanning. 74 (90%) children underwent non-surgical treatment. Surgical treatment was performed in 6 children with continued bleeding and in 2 patients with delayed bleeding. Experimentally, blood from a peripheral vein of animals was taken and injected into the peritoneal cavity. Posthumously, 12 sections of the parietal peritoneum from rabbits for histological examination were taken. Statistical processing of the obtained data was carried out by the method of descriptive statistics. Statistical significance of mean differences was assessed using the Mann–Whitney test, and qualitative data — using Fisher's exact F-test. Differences were considered significant at p ≤0.05.

Results. The volume of hemoperitoneum in children with non-surgical treatment of spleen injury did not exceed 15% of the circulating blood volume. In 97.3% of cases, blood resorption from the peritoneal cavity occurred within 14 days. With non-surgical treatment, chronic abdominal pain was registered in 1.35% of cases, with surgical treatment — in 62.5% (p=0.000011). None of the patients after non-surgical treatment of splenic injury had adhesive intestinal obstruction, while after laparotomy it occurred in 25% of cases (p=0.0084). It has been experimentally established on animals that hemoperitoneum without damage to the peritoneal mesothelium was accompanied by the development of aseptic inflammation. On the 3rd day, neutrophilic leukocytes accumulated in the peritoneum. Under aseptic conditions, no damage to the mesothelium occurred. By the 10th day, the inflammation stopped. On the 20th and 30th days, there were no additional fibrin deposits.

Conclusion. The presence of blood in the peritoneal cavity without damage to the mesothelium is not a risk factor for the formation of adhesions.

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About the authors

Ilia A Pikalo

Irkutsk State Medical University

Author for correspondence.
Email: pikalodoc@mail.ru
ORCID iD: 0000-0002-2494-2735
https://mir.ismu.baikal.ru/ismu/page_user.php?id=1862

M.D., Cand. Sci. (Med.), Head of Depart., Depart. of Emergency Medical Care

Russian Federation, Irkutsk, Russia

Vladimir V. Podkamenev

Irkutsk State Medical University

Email: vpodkamenev@mail.ru
ORCID iD: 0000-0003-0885-0563

M.D., D. Sci. (Med.), Prof., Depart. of Pediatric Surgery

Russian Federation, Irkutsk, Russia

Evgeniy A. Titov

East-Siberian Institute of Medical and Ecological Research

Email: g57097@yandex.ru
ORCID iD: 0000-0002-0665-8060

Cand. Sci. (Biol.), Senior Research Officer, Laboratory of Biomodeling and Translational Me­dicine

Russian Federation, Angarsk, Russia

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2. Рис. 1. Адгезия эритроцитов к брюшине. Окраска гематоксилином и эозином: а — увеличение ×100; б — увеличение ×400; I — мезотелий; II — пограничная базальная мембрана

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3. Рис. 2. Микроскопия на 3-и сутки. Окраска гематоксилином и эозином, увеличение ×400: 1 — рекрутирование лейкоцитов; 2 — активация перитонеальных макрофагов; I — пограничная базальная мембрана; II — собственная пластинка брюшины

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4. Рис. 3. Париетальная брюшина на 10-е сутки. Окраска гематоксилином и эозином, увеличение ×400: 1 — лейкоциты; I — пограничная базальная мембрана

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5. Рис. 4. Препараты париетальной брюшины на 20-е (а) и 30-е (б) сутки. Окрашивание гематоксилином Вейгерта (по Ван-Гизону), увеличение ×100: I — мезотелий; II — пограничная базальная мембрана; III — собственная пластинка брюшины

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