Anti-Inflammatory Effects of Peritoneal Lavage in Acute Pancreatitis

Abstract

Peritoneal lavage has a systemic anti-inflammatory effect in severe AP and may be able to decrease the severity of severe AP.

Role of Peritoneal Macrophages on Local and Systemic Inflammatory Response in Acute Pancreatitis

“…28 Recently, we have demonstrated that peritoneal lavage in an experimental model of acute pancreatitis not only leads to a decrease in serum levels of TNF-and IL-6 but also results in an increase in serum levels of IL-10. 33 (Table 4). We have also demonstrated in the pancreatic tissue a reduction in cycloxygenase-2 and inducible nitric oxide synthase expression.…”

“…We have also demonstrated in the pancreatic tissue a reduction in cycloxygenase-2 and inducible nitric oxide synthase expression. 33 ( Table 4. Effect of peritoneal lavage on systemic inflammation in acute pancreatitis (AP).…”

Usefulness of Early-phase Peritoneal Lavage for Treating Severe Acute Pancreatitis

“…Peritoneal lavage was started within 72 hours from the initial onset of symptoms in 20 patients (87%). The duration of peritoneal lavage was seven (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) days. The duration of peritoneal lavage was correlated with the SIRS score (r=0.52; p=0.036), number of prognostic factors according to the revised Japanese criteria (r=0.70; p= 0.0054), Ranson score (r=0.49; p=0.049) and serum Creactive protein level (r=0.65; p=0.0096) at the start of peritoneal lavage.…”

“…Trials performed in the 1980s and 1990s reported that peritoneal lavage does not reduce the rate of mortality or complications of this disease (8); however, a recent study demonstrated the anti-inflammatory effects of peritoneal lavage in patients with acute pancreatitis (9). Ascitic fluids in acute pancreatitis patients contain high levels of proinflammatory cytokines and pancreatic enzymes, such as phospholipase A2, which play a role in the development of distant organ dysfunction (10)(11)(12).…”

“…Ascitic fluids in acute pancreatitis patients contain high levels of proinflammatory cytokines and pancreatic enzymes, such as phospholipase A2, which play a role in the development of distant organ dysfunction (10)(11)(12). Peritoneal lavage decreases not the ascitic, but rather the serum, levels of proinflammatory cytokines and pancreatic enzymes (9,13). In addition, longterm (seven days), but not short-term (two or three days), peritoneal lavage has been reported to reduce the incidence of sepsis and the rate of death from sepsis among patients with severe acute pancreatitis (14,15).…”