Bacterial translocation from the gastrointestinal tract is central to
current concepts of endogenous sepsis, Studies were designed to evalua
te the potential relevance of translocation to the high incidence of i
nfection in obstructive jaundice, Sprague-Dawley rats underwent laparo
tomy and division of the bile duct or sham ligation. In Study 1, rats
were sacrificed after 24 hr, 1 week, and 3 weeks and the mesenteric ly
mph node complex, cecum, and blood were cultured and plasma endotoxin
was measured. In Studies 2 and 3, sham- and bile duct-ligated rats wer
e challenged after 1 week with operative trauma and intravenous endoto
xin, respectively. Animals were sacrificed after a further 24 hr. No t
ranslocation was observed in sham-operated rats. Although colonization
of the mesenteric lymph nodes was not seen in bile duct-ligated rats
after 24 hr, this was evident in 75% of rats after 1 and 3 weeks. Surg
ical trauma and endotoxin produced bacterial translocation in 33 and 4
0%, respectively, of sham-operated animals; this was enhanced in bile
duct-ligated rats to 75% (P < 0.01 vs shams) and 93% (P < 0.001 vs sha
ms), respectively. Endotoxin resulted in positive blood cultures in 71
% of jaundiced rats compared with none of the sham group injected with
endotoxin (P < 0.001). Biliary obstruction produces bacterial translo
cation and this process is enhanced by surgical trauma and endotoxin.
The data support the thesis of gut barrier failure in jaundice and sug
gest that therapies targeted toward decreasing bacterial translocation
may merit evaluation in the prophylaxis and treatment of infection in
the jaundiced patient. (C) 1996 Academic Press, Inc.