Do iatrogenic serosal injuries result in small bowel perforation in a rabbit model?

Abstract

Background and objectives: Surgical dogma dictates that serosal injuries should be repaired during laparotomy as these injuries may result in localised areas of bowel ischaemia and may perforate. No study has investigated whether there is a correlation between the extent of serosal injuries and the risk for perforation under normal physiological conditions. We hypothesized that small bowel serosal injuries do not result in early or late perforation at physiological intraluminal pressures regardless of their size.

Methods: An in-vivo rabbit small bowel serosal injury model was developed and two experiments were conducted. The first – to determine whether and at which pressures various lengths and circumferences of serosal injuries in small bowel result in immediate bowel perforation – was performed infusing saline into isolated bowel segments with or without a variety of serosal injuries. In the second study – to determine whether or not serosal injuries result in delayed perforation – a range of injuries was created in rabbits and the effect assessed at re-laparotomy 5 days after the creation of the injury.

Results: No perforations were observed at the site of serosal injuries at physiological intraluminal pressures. Perforations occurred at 43.7+18.6 cmH₂O, 23.3+14.4 cmH₂O, and 24.4+23.9 cmH₂O for controls, 4 cm long and 100% circumference serosal injuries respectively (p-value = 0.18 for various lengths and 0.71 for various circumferences). No serosal injuries perforated within 72 or 120 hours after creation.

Conclusion: Small bowel serosal injuries do not perforate or leak at physiological intraluminal pressures, either at the time of creation or up to 120 hours thereafter.

Keywords: serosal injury, laparotomy, perforation