The Role Of Heparin In Treatment Of Experimental Peritonitis

Background: To produce peritonitis experimentally in albino rats by creation of a necrotic loop of terminal Ileum. Study of peritonitis and gross changes in peritoniteal cavity and to study the effect of single dose heparin (Anticoagulant) in experimentally produced peritonitis. Also to study and compare the effect of repeated small dosage of heparin in peritonitis. Material and MethodsThe rats were divided into 6 groups, under the 2 experiments. So each group comprised of 8 rats. The peritonitis was proceduced by Rasto's method, in which the peritonitis was caused by a gangrenous loop of small intestine . two types of experiment were carried out:1. Experiment 1 : The gangrenous loop which produced peritonitis was excised after 24 hours, normal saline was given in control group,whereas heparin as a single dose and heparin in small repeated dose were given by sub-cutaneous or intra-peritoneal route for 3 days. No abdominal toilet or antibiotics were given during the time. The surviving as well as the dead rats during observation period were subjected to laparotomy and detailed pathology of peritoneum was studied. 2. Experiment 2 : In this group the gangrenous loop was not resected after 24 hours and normal saline was given in control group 0.2 ml., or heparin in a single dose 50 I.U. or heparin in small repeated dose 20 I.U. twice a day for three days.All the rats were continuously observed during the post-operative period for evidence of any complications. Results:The peritonitis produced by a necrotic bowel loop was severe & brino-purulent.The formation of inter-mesentric abscess in control group was much more evident than the heparinised rats. The size of inter-mesentric abscess was smaller in treated group of albino rats than in control.The incidence of adhesion formation was much more in control group, than in the heparin group, the adhesion were very less friable and easily breakable. The survival rate in heparin treatment group was 75% to 87.5% as compared to the control group, where the survival rate was 50% only.The mortality in the control group, where the necrotic loop, was not resected was as high as 87.5% and rats died within 8 days after operation whereas the mortality rate in treatment group was low that is, from 50% to 60% only.Conclusion: By comparison and contrast of the results of the difference treatment group, it become evident that survival in the treated group was signicantly better than control group. About the evidence of intra-peritoneal infection, it shows that in treated group clearance of peritonitis was much faster than the control group of albino rats:The number and size of intramesentric abscesses were also smaller in treated group. There was also a little benecial effect on adhesion in heparinised albino rats as compared to control group.So heparin in small repeated doses has denitely a signicant effect on secondary bacterial peritonitis and its subsequent results.

Intra peritoneal ascending colon in parastomal hernial sac.

The rate of parastomal hernia reported varies from 5% to 80%. It forms when the abdominal wall defect is continually stretched by the tangential forces applied along the circumference of the abdominal wall opening. The presence of parastomal hernia along with intraperitoneal ascending colon, caecum and terminal ileum along with ileal perforation is a rare entity.

A clinical study of intestinal stomas: its indications and complications.

Background: Intestinal stoma is an opening for fecal diversion. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it. Methods: This is a prospective study was carried out in a surgical unit of Hamidia Hospital, Gandhi Medical College, Bhopal from January, 2012 to December,2012. Data was collected by meticulous history taking including age, gender, indication, type of stoma, type of surgery, careful clinical examination, appropriate operative findings and follow up of the cases. The results were collected, analyzed and compared with other studies. Results: A total of 100 patients were evaluated age ranged between 12- 85 years (50.5 ± 29.01 years) Male to female ratio was 7:3. Of the 100 patients 97 were admitted in emergency while 3 in out-patient department. The most common type of stoma made was loop ileostomy (64%) followed by sigmoid colostomy (11%) and transverse loop colostomy (9%). Main indication for a stoma formation was enteric perforation (38%) followed by Koch’s abdomen (18%). Of the various complications encountered with intestinal stoma, peristomal skin irritation (36%) was the most consistent complication followed by laparotomy wound infection (13%). Conclusions: Inspite of vast exposure of general surgeons towards stoma formation the complications are inevitable. Early detection of complication and its timely management is the keystone.