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

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.

Keywords

children / spleen injury / hemoperitoneum / adhesions

References

[1] Karpovа IYu, Strizhenok DS, Yegorskaya LE, Ladygina TM, Egorskaya AT. Emergency ultrasound diagnosis and principles of starting therapy for abdominal trauma in children. Medical almanac. 2019;(5–6):69–74. (In Russ.) DOI: 10.21145/2499-9954-2019-5-69-74.

[2] Карпова И.Ю., Стриженок Д.С., Егорская Л.Е., Ладыгина Т.М., Егорская А.Т. Неотложная ультразвуковая диагностика и принципы стартовой терапии при травме живота у детей. Медицинский альманах. 2019;(5–6):69–74. DOI: 10.21145/2499-9954-2019-5-69-74.

[3] Podkamenev VV, Pikalo IA. Criteria for the choice of the treatment for the children with splenic lesions. Detskaya khirurgiya. 2014;18(5):23–27. (In Russ.)

[4] Подкаменев В.В., Пикало И.А. Критерии выбора способа лечения детей с повреждением селезёнки. Детская хирургия. 2014;18(5):23–27. EDN: SNTWMF.

[5] Ulugmuratov AA, Mavlyanov FSh, Mirzaev ZKh, Normurodov DK, Islamov AR. The effectiveness of video laparoscopy in the dia-gnosis and treatment of closed injuries of the parenchymal organs of the abdominal cavity in children. Detskaya khirurgiya. 2019;23(1S4):62. (In Russ.)

[6] Улугмуратов А.А., Мавлянов Ф.Ш., Мирзаев З.Х., Нормуродов Д.К., Исламов А.Р. Эффективность видеолапароскопии в диагностике и лечении закрытых травм паренхиматозных органов брюшной полости у детей. Детская хирургия. 2019;23(1S4):62.

[7] Akilov KhA, Primov FSh, Urmanov NT, Asadov ShYa. Possibilities and prospects of endosurgery for closed abdominal injuries in severe concomitant trauma in children. Vestnik khirurgicheskoy gastroenterologii. 2016;(3):145–146. (In Russ.)

[8] Акилов Х.А., Примов Ф.Ш., Урманов Н.Т., Асадов Ш.Я. Возможности и перспективы эндохирургии закрытых повреждений живота при тяжёлой сочетанной травме у детей. Вестник хирургической гастроэнтерологии. 2016;(3):145–146. EDN: WTIHXP.

[9] Tsap NA, Komarova SJ, Ogarkov IP, Chukreev VI, Potapenko JV. Trauma of abdominal and retroperitonal organs in children: optimisation of dyagnostics and treatment. Russian journal of pediatric surgery, anesthesia and intensive care. 2010;(1):104–107. (In Russ.)

[10] Цап Н.А., Комарова С.Ю., Огарков И.П., Чукреев В.И., Потапенко Ю.В. Травматические повреждения органов брюшной полости и забрюшинного пространства у детей: оптимизация диагностики и лечения. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2010;(1):104–107.

[11] Kristoffersen KW, Mooney DP. Long-term outcome of nonoperative pediatric splenic injury management. J Pediatr Surg. 2007;42:1038–1042. DOI: 10.1016/j.jpedsurg.2007.01.039.

[12] Kuzyakova LM, Skalsky SV, Stepanova ЕF, Ogay MA, Glizhova TN, Sokolova TF, Lokarev AV, Kovtun EV. Influence of blockers of slow calcium channels on the processes of proliferation and collagenogenesis of fibroblasts in the formation of spices in the abdominal cavity. Medical News of North Caucasus. 2019;14(1–2):208–211. (In Russ.) DOI: 10.14300/mnnc.2019.14016.

[13] Кузякова Л.М., Скальский С.В., Степанова Э.Ф., Огай М.А., Глижова Т.Н., Соколова Т.Ф., Локарев А.В., Ковтун Е.В. Влияние блокаторов медленных кальциевых каналов на процессы пролиферации и коллагеногенеза фибробластов при образовании спаек в брюшной полости. Медицинский вестник Северного Кавказа. 2019;14(1–2):208–211. DOI: 10.14300/mnnc.2019.14016.

[14] Lavreshin PM, Gobedgishvili VK, Kelasov IG, Gobedgishvili VV. Profilaxis of intraabdominal adhesion in patients with mechanical abdominal trauma and hemoperitoneum. Bulletin of experimental and clinical surgery. 2013;6(2):148–154. (In Russ.)

[15] Лаврешин П.М., Гобеджишвили В.К., Келасов И.Г., Гобеджишвили В.В. Профилактика развития внутрибрюшных спаек у больных с механической травмой живота, осложнённой гемоперитонеумом. Вестник экспериментальной и клинической хирургии. 2013;6(2):148–154. EDN: RJDPPP.

[16] Tsai JM, Shoham M, Fernhoff NB, George BM, Marjon KD, McCracken MN, Kao KS, Sinha R, Volkmer AK, Miyanishi M, Seita J, Rinkevich Y, Weissman IL. Neutrophil and monocyte kinetics play critical roles in mouse peritoneal adhesion formation. Blood Adv. 2019;3(18):2713–2721. DOI: 10.1182/bloodadvances.2018024026.

[17] Tsai JM, Sinha R, Seita J, Fernhoff N, Christ S, Koopmans T. Surgical adhesions in mice are derived from mesothelial cells and can be targeted by antibodies against mesothelial markers. Sci Transl Med. 2018;10(469):eaan6735. DOI: 10.1126/scitranslmed.aan6735.

[18] Ten Broek RP, Issa Y, van Santbrink EJ, Bouvy ND, Kruitwagen RF, Jeekel J, Bakkum EA, Rovers MM, van Goor H. Burden of adhesions in abdominal and pelvic surgery: systematic review and meta-analysis. BMJ. 2013;347:f5588. DOI: 10.1136/bmj.f5588.

[19] Rami Reddy SR, Cappell MS. A systematic review of the clinical presentation, diagnosis, and treatment of small bowel obstruction. Curr Gastroenterol Rep. 2017;19(6):28. DOI: 10.1007/s11894-017-0566-9.

[20] Ten Broek RPG, Krielen P, Di Saverio S, Coccolini F, Biffl WL, Ansaloni L, Velmahos GC, Sartelli M, Fraga GP, Kelly MD, Moore FA, Peitzman AB, Leppaniemi A, Moore EE, Jeekel J, Kluger Y, Sugrue M, Balogh ZJ, Bendinelli C, Civil I, Coimbra R, Moya MD, Ferrada P, Inaba K, Ivatury R, Latifi R, Kashuk JL, Kirkpatrick AW, Maier R, Rizoli S, Sakakushev B, Scalea T, Søreide K, Weber D, Wani I, Abu-Zidan FM, De'Angelis N, Piscioneri F, Galante JM, Catena F, van Goor H. Bologna guidelines for diagnosis and management of adhesive small bo-wel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2018;13:24. DOI: 10.1186/s13017-018-0185-2.

[21] Moris D, Chakedis J, Rahnemai-Azar AA, Wilson A, Hennessy MM, Athanasiou A, Beal EW, Argyrou C, Felekouras E, Pawlik TM. Postoperative abdominal adhesions: Clinical significance and advances in prevention and management. J Gastrointest Surg. 2017;21:1713–1722. DOI: 10.1007/s11605-017-3488-9.

[22] Fredriksson F, Christofferson RH, Lilja HE. Adhesive small bowel obstruction after laparotomy during infancy. Br J Surg. 2016;103(3):284–289. DOI: 10.1002/bjs.10072.

[23] Liu T, Liu F, Peng L-W, Chang L, Jiang Y-M. The peritoneal macrophages in inflammatory diseases and abdominal cancers. Oncol Res. 2018;26(5):817–826. DOI: 10.3727/096504017X15130753659625.

[24] Skuljec J, Jirmo AC, Habener A, Talbot SR, Pul R, Grychtol R, Aydin M, Kleinschnitz C, Happle C, Hansen G. Absence of regulatory T cells causes phenotypic and functional switch in murine peritoneal macrophages. Front Immunol. 2018;9:2458. DOI: 10.3389/fimmu.2018.02458.

[25] Cossado AA. F4/80 as a major macrophage marker: the case of the peritoneum and spleen. In: Kloc M, editor. Macrophages. Springer International Publishing; 2017. р. 161–179. DOI: 10.1007/978-3-319-54090-0_7.

[26] Braun KM, Diamond MP. The biology of adhesion formation in the peritoneal cavity. Semin Pediatr Surg. 2014;23:336–343. DOI: 10.1053/j.sempedsurg.2014.06.004.

[27] Shapkina AN, Kozlova MV, Shmyreva ES, Shumatov VB. How to avoid splenectomy in a child with splenic trauma. Pacific Medical Journal. 2018;(1):72–74. (In Russ.) DOI: 10.17238/PmJ1609-1175.2018.1.72–74.

[28] Шапкина А.Н., Козлова М.В., Шмырева Е.С., Шуматов В.Б. Как избежать спленэктомии у ребёнка с травмой селезёнки. Тихоокеанский медицинский журнал. 2018;(1):72–74. DOI: 10.17238/PmJ1609-1175.2018.1.72–74.

[29] Sjövall A, Hirsch K. Blunt abdominal trauma in children: risks of nonoperative. J Pediatr Surg. 1997;8(32):1169–1174. DOI: 10.1016/s0022-3468(97)90676-x.

[30] Coccolini F, Montori G, Catena F, Kluger Y, Biffl W, Moore EE, Reva V, Bing C, Bala M, Fugazzola P, Bahouth H, Marzi I, Velmahos G, Ivatury R, Soreide K, Horer T, Ten Broek R, Pereira BM, Fraga GP, Inaba K, Kashuk J, Parry N, Masiakos PT, Mylonas KS, Kirkpatrick A, Abu-Zidan F, Gomes CA, Benatti SV, Naidoo N, Salvetti F, Maccatrozzo S, Agnoletti V, Gamberini E, Solaini L, Costanzo A, Celotti A, Tomasoni M, Khokha V, Arvieux C, Napolitano L, Handolin L, Pisano M, Magnone S, Spain DA, de Moya M, Davis KA, De Angelis N, Leppaniemi A, Ferrada P, Latifi R, Navarro DC, Otomo Y, Coimbra R, Maier RV, Moore F, Rizoli S, Sakakushev B, Galante JM, Chiara O, Cimbanassi S, Mefire AC, Weber D, Ceresoli M, Peitzman AB, Wehlie L, Sartelli M, Di Saverio S, Ansaloni L. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg. 2017;12:40. DOI: 10.1186/s13017-017-0151-4.

[31] Gates RL, Price M, Cameron DB, Somme S, Ricca R, Oyetunji TA. Non-operative management of solid organ injuries in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. J Pediatr Surg. 2019;54:1519–1526. DOI: 10.1016/j.jpedsurg.2019.01.012.

[32] Shapkin YuG, Maslyakov VV. Typical complications in the long-term period in patients operated for trauma of the spleen. Grekov's bulletin of surgery. 2009;168(3):39–43. (In Russ.)

[33] Шапкин Ю.Г., Масляков В.В. Типичные осложнения в отдалённом послеоперационном периоде у больных, оперированных при травме селезёнки. Вестник хирургии И.И. Грекова. 2009;168(3):39–43. EDN: KVJWWP.

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