Direct peritoneal resuscitation improves survival and decreases inflammation after intestinal ischemia and reperfusion injury

Trevor D. Crafts, Erin Bailey Hunsberger, Amanda R. Jensen, Frederick J. Rescorla, Mervin C. Yoder, Troy A. Markel

Research output: Contribution to journalArticle

7 Scopus citations


Background: Direct peritoneal resuscitation (DPR) has previously been shown to alter blood flow in the small bowel mesenteric vessels in models of intestinal ischemia. However, a survival advantage or its effects on local tissue inflammation have not been previously demonstrated. We hypothesized that DPR would increase survival and decrease intestinal tissue inflammation after intestinal ischemia and reperfusion (I/R) injury. Methods: Eight-week-old male C57Bl6J mice were anesthetized and underwent midline laparotomy. I/R and DPR groups were exposed to superior mesenteric artery occlusion for 60min with a nontraumatic clamp. Immediately after removal of the clamp, 1mL of phosphate-buffered saline, 1mL of minimal essential media, or 1mL of minimal essential media supplemented with fetal bovine serum, penicillin and/or streptomycin, and glutamine were placed into the abdominal cavity of DPR groups. Animals were then closed in two layers and allowed to reperfuse for 6h (cytokine analysis, n=6 per group) or 7d (survival analysis, n=10 per group). After 6h of reperfusion, animals were euthanized. Intestines were harvested and homogenized. Extracts were quantified for total protein content (Bradford assay), myeloperoxidase activity, tissue inflammatory cytokine, and growth factor production. P<0.05 was significant. Results: I/R caused marked intestinal ischemia, significant mortality, and a significant increase in tissue cytokine and growth factor levels (P<0.05). Seven-day survival was 30% for I/R without treatment and rose to 60% with DPR therapy using phosphate-buffered saline as the dialysate. DPR using plain MEM or MEM with supplements after ischemia increased 7-d survival to 90% (P<0.05). DPR also significantly decreased intestinal tissue levels of myeloperoxidase, as well as intestinal tissue levels of multiple growth factors and inflammatory cytokines. Conclusions: DPR increases survival and decreases intestinal inflammation after intestinal I/R injury. Translational applications are readily achievable and should be considered for patients with intestinal ischemic pathology.

Original languageEnglish (US)
JournalJournal of Surgical Research
Issue number2
StatePublished - Dec 1 2015



  • Intestinal ischemia
  • Mesenteric ischemia
  • Necrotizing enterocolitis
  • Peritoneal resuscitation
  • Survival

ASJC Scopus subject areas

  • Surgery

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