Gut barrier function damage following multiple firearm injuries in a porcine model.

OBJECTIVE

To study the characteristics and pathogenesis of gut barrier damage following multiple firearm injuries in a porcine model.

METHODS

Twenty-four small pigs were divided into 4 groups: control group (n = 6, group C), group H (n = 6, gunshot-induced tangential fracture of parietal bone), group L (n = 6, gunshot-induced comminuted fracture of bilateral femora) and group M (n = 6, combined group H + L). Gastric intramucosal pH (pHi), plasma endotoxin levels in portal vein, and plasma D-lactate levels were measured and blood samples were cultured at different intervals after trauma. The animals were sacrificed at 72 h following trauma and intestinal tissues were harvested for pathological examination and diamine oxidase (DAO) activity measurement.

RESULTS

In group M at 72 h, pHi was significantly lower than that of group H and L ( P < 0.01), and plasma endotoxin level was significantly higher than that of group H (P < 0.01) and group L (P < 0.05). Simultaneously, in group M, D-lactate level was markedly higher than that of group H ( P < 0.01), and incidence of positive blood culture was much higher than that of group H and L ( P < 0.05). Necrosis and exfoliation were revealed at ileum villus top in all trauma groups, especially in group M, in which ileum DAO activity declined most significantly as well.

CONCLUSION

Multiple trauma is prone to cause gastrointestinal ischemia even without hemorrhagic shock. The damage of gut barrier in multiple trauma appears to be more severe than that in one-site trauma, thereby promoting gut-derived endotoxemia and bacterial translocation and contributing to the development of endogenous infection.