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Updated: Jun 5, 2025
Postoperative Ileus Murine Model
Published on: July 12, 2024
Intra-peritoneal Povidone-iodine Irrigation Decreases Abscesses in a Perforated Appendicitis Murine Model
Derek J Krinock1, Krista Stephenson1, David Irby1
1Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Insights
Povidone-iodine irrigation effectively reduces post-operative abscesses in perforated appendicitis models. However, it also increases adhesion formation, highlighting a critical trade-off in surgical care.
Area of Science:
- Surgical research
- Medical innovation
- Clinical practice
Background:
- Children with perforated appendicitis often develop post-operative intra-abdominal abscesses (IAA).
- The efficacy of intra-peritoneal irrigation for preventing IAA is debated.
- A murine model of perforated appendicitis was used to investigate irrigation's effects.
Purpose of the Study:
- To evaluate the impact of different intra-peritoneal irrigation solutions on post-operative IAA formation.
- To assess the influence of irrigation on intra-peritoneal adhesion development.
- To compare normal saline, povidone-iodine (PVI), and tacrolimus irrigation effects.
Main Methods:
- A cecal ligation and puncture model simulated perforated appendicitis in mice.
- Following initial surgery, mice underwent a second procedure involving distal cecectomy and irrigation.
- Irrigation groups included: no irrigation, normal saline, PVI, tacrolimus, and PVI followed by tacrolimus.
Main Results:
- Povidone-iodine (PVI) irrigation significantly decreased abscess counts at both 2 weeks and 2 months.
- PVI irrigation was associated with more severe intra-peritoneal adhesions.
- Tacrolimus demonstrated a reduction in adhesions, with severity dependent on the irrigation solution used.
Conclusions:
- Intra-peritoneal povidone-iodine irrigation is effective in reducing post-operative intra-abdominal abscesses.
- However, povidone-iodine irrigation also leads to an increase in intra-peritoneal adhesion formation.
- The findings suggest a balance between abscess prevention and adhesion mitigation is crucial.
Background:
Children with perforated appendicitis frequently form post-operative intra-abdominal abscesses (IAA). Intra-peritoneal irrigation for prevention remains controversial. Using a perforated appendicitis murine model, we sought to determine the effect of intra-peritoneal irrigation on post-operative IAA and adhesion formation.
Methods:
A survival operation was performed where cecal ligation and puncture was used to simulate perforated appendicitis. After 72 h, mice underwent a second operation where a distal cecectomy and intra-peritoneal irrigation was performed. Mice were assigned to a no irrigation group or one of four irrigation groups: normal saline, povidone-iodine (PVI), tacrolimus, or PVI followed by tacrolimus. At 2-weeks or 2-months after the second survival operation, mice were euthanized and IAAs were counted, measured, and cultured. Intra-peritoneal adhesion severity was graded on a 4-point scale. Statistical analysis compared IAA numbers and adhesion grade between the irrigation groups.
Results:
In the 2-week cohort, prevalence of IAA was 78 % (n = 129). Type of irrigation solution was associated with abscess development (p < 0.001). Pairwise comparisons demonstrated PVI alone decreased abscess count. PVI irrigation caused more severe adhesions while tacrolimus decreased adhesions and adhesion grade was dependent on irrigation solution (p < 0.001). In the 2-month cohort, similar responses were observed with decreased abscess numbers in the PVI group (p = 0.006) but increased adhesion burden (p = 0.002).
Conclusion:
Povidone-iodine irrigation decreases intra-abdominal abscess formation, but increases adhesion formation.
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