Surg Today (2006) 36:519–524 DOI 10.1007/s00595-006-3196-7 Liver Injury in Sepsis and Abdominal Compartment Syndrome in Rats M.A. Tolga Muftuoglu 1 , Ali Aktekin 1 , Nilgun C. Ozdemir 2 , and Abdullah Saglam 1 Departments of 1 General Surgery and 2 Pathology, Haydarpasa Numune Research and Training Hospital, Uskudar, Istanbul, Turkey Introduction Abdominal compartment syndrome (ACS) is defined as “increased intra-abdominal pressure within the abdomen, leading to microvascular compromise in vital organs.” Abdominal compartment syndrome results in impairment of cardiovascular, respiratory, gas- trointestinal, genitourinary, and central nervous system functions. Intra-abdominal pressure and increased intra-abdominal pressure was initially described in the 18th century. The importance of ACS has been well documented in last 20 years since the introduction of laparoscopy. Abdominal trauma, intra-abdominal in- fection, pancreatitis, an accumulation of blood in the abdominal cavity, and retroperitoneal hematomas with massive fluid load may all contribute to increased intra- abdominal pressure and ACS. As long ago as 2735 B.C., the Chinese Emperor, Sheng Nung, described the use of herbal medicines to treat fever brought on by sepsis. 1 Sepsis is a clinical condition caused by the immune response of a host to infection or trauma, which is characterized by systemic inflammation and coagulation abnormalities. 2 It can range in severity from a systemic inflammatory re- sponse to organ dysfunction, multiple organ failure, and ultimately, death. Sepsis can develop from, but is most commonly associated with severe abdominal or lung infections such as pneumonia. People with a compro- mised immune system are especially prone to septic shock. Such patients include those with autoimmune deficiency syndrome, those receiving cancer treatments, the very young, and the very old. Despite an increased understanding of the mecha- nisms of sepsis and the improvements in its manage- ment, the high mortality rates associated with sepsis and multiorgan failure have remained unchanged. Both sep- sis and ACS have been investigated extensively in vari- ous experimental studies; however, to our knowledge no other study has focused on liver injury under these Abstract Purpose. To evaluate the extent of liver injury after the onset of sepsis and abdominal compartment syndrome (ACS) in rats. Methods. We divided 60 rats into four groups of 15. Group 1 was the sham group. In group 2, sepsis was induced by cecal puncture and ligation; in group 3, ACS was created by placing a catheter in the abdominal cavity; and in group 4, both sepsis and ACS were induced simultaneously. Liver sections stained with hematoxylin–eosin were assessed pathologically, and liver injury was defined by the following five pathologi- cal patterns: spotty necrosis, capsular inflammation, portal inflammation, ballooning degeneration, and ste- atosis of the liver. We revised a new scoring system, called “Hepatic Injury Severity Scoring” (HISS), to evaluate the liver injury in sepsis, ACS, and sepsis plus ACS. Blood was collected for liver function tests. Results. The total scores of groups 1, 2, 3, and 4 were 18, 92, 86, and 123, respectively. There were significant dif- ferences in histopathologic grade between group 1 and groups 2, 3, and 4 (P < 0.05). Aspartate aminotrans- ferase, alanine aminotransferase, alkaline phosphatase, and total bilirubin levels were significantly higher in group 4 than in the other three groups. Conclusions. The findings of this study showed that liver function severely affected the onset of ACS and sepsis. The liver injury resulting from sepsis plus ACS is more severe than that resulting from either one independently. Key words Abdominal compartment syndrome · Histo- pathologic grade · Liver injury · Sepsis Reprint requests to: M.A. T. Muftuoglu, Mustafa Mazhar Bey Sok. 11/3, Feneryolu, 34724 Kadikoy, Istanbul, Turkey Received: May 17, 2005 / Accepted: November 15, 2005