Abstracts
1997 Digestive Disease Week

Dextran may lower septic complications in necrotizing pancreatitis.

J Werner, A Secchi*, J Schmidt, H Schmidt*, MM Gebhard#, C Herfarth, E Klar. Departments of Surgery, *Anesthesiology and #Experimental Surgery, University of Heidelberg, Germany.

One mechanism of sepsis in acute pancreatitis seems to be a dramatic reduction of intestinal blood flow with subsequent increase of mucosal permeability and bacterial translocation. Dextran has been shown to improve pancreatic microcirculation and to reduce acinar necrosis and mortality in necrotizing pancreatitis most efficient compared to other volume therapies. The aim of this study was to investigate whether dextran has any effect on the impaired intestinal blood flow. Methods: Necrotizing pancreatitis was induced in 14 Wistar-rats by intraductal glycodeoxycholic acid (10mM) and cerulein i.v. (5µg/kg/h) over 6 hours. Control animals received intraductal and intravenous saline. 6 hours after intraductal infusion the small intestine was opened antimesenterically and intravital microscopy of the capillary blood flow of the microvilli was performed after injection of fluorescein labeled erythrocytes (baseline, blood flow assessed in nl/min/capillary). Animals were then randomly assigned to treatment with either Ringer (RL, 32ml/kg) or Dextran (D, 8ml/kg) i.v. over 0.5 hours. Intravital microscopy measurements were repeated 1 and 2 hours after therapy. Results: Intestinal perfusion was significantly reduced after induction of pancreatitis (1.63±0.07 RL, 1.46±0.05 D) compared to control animals (7.73±0.2, p<0.001) at baseline. The mucosal blood flow was increased to 2,12±0.14 after 1 hour (p<0.01 vs. baseline), but was back to baseline (1.66±0.09) 2 hours after Ringer infusion. Dextran increased the intestinal blood flow to 5.95±0.20 after 1 and to 5.33±0.21 after 2 hours, (p<0.001 vs. baseline). Conclusions: Dextran increases the impaired mucosal blood flow in necrotizing pancreatitis, in contrast to a 4-fold volume of Ringer's solution. Thus the preservation of mucosal blood flow may decrease bacterial translocation and explain in part the observed reduction of mortality in this model of severe acute pancreatitis after dextran treatment.