ABSTRACT
D amage control surgery has undoubtedly increased the survival of severely injured patients; however, a subset of these salvaged patients go on to develop the devastating complication of the abdominal compartment syndrome (ACS). Clinical studies have demonstrated a clear association of the ACS with multiple organ failure (MOF). In animals, the ACS increases systemic levels of pro-inflammatory cytokines, primes neutrophils for cyto toxicity and results in remote organ injury. Both clinical and human studies confirm that the ACS causes a disproportionate decrease in mesenteric perfusion, which can occur even in the absence of hypotension and decreased cardiac output. We hypothesize that this ischemia/ reperfusion injury to the gut serves as a second-insult in a two-event model of MOF and further propose that mesenteric lymph is the conduit by which gut-derived proinflammatory agents induce remote organ injury.
