title: Intraintestinal drainage as a damage control surgery adjunct in a hypothermic traumatic shock swine model with multiple bowel perforations.
abstract: BACKGROUND
  Temporary bowel ligation (TL) has been proposed to prevent contamination as a damage control procedure in multiple bowel perforations. However, bacteria translocation and intestinal ischemia may develop in a prolonged duration. We here hypothesized that intraintestinal drainage combined with temporary ligation (D-TL) would decrease intestinal injury and improve survivals in a gunshot multiple bowel perforation swine model in the setting of a damage control surgery.
  
  
  METHODS
  The abdomen was shot one time with an experimental modified gun whereas pigs were hemorrhaged to a mean arterial pressure of 40 mm Hg and maintained in shock for 40 min. Cold lactated Ringer solution was gradually infused to induce hypothermia. Animals were randomized to primary anastomosis, TL and intraintestinal D-TL groups (n = 8). Animals were resuscitated for 12 h with the shed blood and lactated Ringer solution. Delayed anastomosis was performed in TL and D-TL animals after resuscitation. Surviving animals were humanely killed 24 h after operation. Systemic hemodynamic parameters were recorded and blood samples were obtained for biochemical assays. Intra-abdominal pressure, portal vein and peripheral vein bacterial cultures, small intestine hematoxylin-eosin staining, and transmission electron microscopy examination were performed at 0, 2, 6, 12, and 24 h after the surgery.
  
  
  RESULTS
  All animals suffered extreme physiologic conditions as follows: hypothermia, severe acidosis, hypotension, and depressed cardiac output. Compared with the primary anastomosis and TL group, D-TL animals required less resuscitation fluid, suffered a lower intra-abdominal hypertension and bacterial translocation, normalized lactate levels faster, had lower serum creatine kinase, aspartate aminotransferase levels and tissue TNF-α level, and nuclear factor-kB activations and thus had greater early survival.
  
  
  CONCLUSIONS
  Compared with primary intestinal anastomosis and TL, rapid bowel ligation combined with intraintestinal drainage as a damage control adjunct improved survivals in a multiple bowel perforation swine model in the setting of damage control surgery.
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China.
authors.forename: Wu
authors.initials: W
authors.lastname: Ji
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China. Electronic address: dingwei_nju@hotmail.com.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Ding
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China.
authors.forename: Xingdong
authors.initials: X
authors.lastname: Liu
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China.
authors.forename: Xiaomin
authors.initials: X
authors.lastname: Kao
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China.
authors.forename: Xingwei
authors.initials: X
authors.lastname: Xu
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, PR China.
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D018988:Bacterial Translocation / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D003131:Combined Modality Therapy; D004195:Disease Models, Animal; D004322:Drainage / Q000379:methods*; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006439:Hemodynamics; D007036:Hypothermia, Induced / Q000379:methods* / Q000401:mortality; D007422:Intestines / Q000293:injuries* / Q000502:physiology; D008026:Ligation; D012774:Shock, Traumatic / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D018709:Statistics, Nonparametric; D034421:Sus scrofa; D001743:Urinary Bladder / Q000502:physiology; D014948:Wounds, Gunshot / Q000150:complications / Q000401:mortality / Q000601:surgery*
chemical_list: D015415:Biomarkers
keywords: Damage control surgery; Gunshot injury; Intestinal injury; Intestinal mucosal barrier; Trauma