GUT BARRIER FAILURE IN EXPERIMENTAL OBSTRUCTIVE-JAUNDICE

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.