RESUMO
Acute peritonitis is still associated with a high mortality rate. Bacterial toxins are rapidly cleared from the peritoneal cavity and may induce general sepsis. The hepatic sinusoidal cells are part of the primary defence against these toxins. The object of this study was to examine ultrastructural alterations of human sinusoidal liver cells from patients undergoing surgical treatment for peritonitis. Liver specimens, obtained from five patients treated with programmed interval peritoneal lavages for peritonitis, were analyzed by electron microscopy. Despite interindividual differences in etiology of peritonitis, the detected ultrastructural alterations displayed a high degree of similarity. Kupffer cells displayed enhanced phagocytotic activity. Numerous Kupffer cell-lymphocyte contacts were observed. Notably, the morphological appearance of the endothelial cells resembled that of an activated phagocytotic cell. The ultrastructural alterations peaked on day 7, and regressed during the course of treatment. Our findings demonstrate that major changes occur in the ultrastructural appearance of both Kupffer cells and sinusoidal endothelial cells in patients with acute peritonitis treated successfully with programmed interval peritoneal lavages. Our data suggest that in peritonitis, a septic spread of toxins and antigens may be modulated by sinusoidal liver cells.
