ENDOTOXEMIA AND INTESTINAL MUCOSAL DYSFUNCTION AFTER THE RELIEF OF OBSTRUCTIVE-JAUNDICE BY INTERNAL AND EXTERNAL DRAINAGE IN RATS

We studied the effects of external and internal biliary drainage on th e development of endotoxemia in a rat model of obstructive jaundice. M ale Donryu rats were allocated to four groups: sham operation, common hepatic bile duct ligation (BDL), internal or external biliary drainag e after BDL, and biliary drainage after BDL with oral endotoxin admini stration. Portal and systemic blood endotoxin concentrations were meas ured and the histomorphology of the intestinal mucosa was examined. Po rtal endotoxemia was observed 7 days after BDL and both portal and sys temic endotoxemia were observed after 14 days. Portal endotoxemia was reversed by both internal and external biliary drainage and systemic e ndotoxemia was prevented. The ratio of villous height to crypt depth i n the mucosa of the terminal ileum was deceased in rats with external drainage. Oral administration of endotoxin induced marked disruption o f the mucosal epithelium in rats with external biliary drainage, but n ot in rats with internal biliary drainage. Significant increases in po rtal and systemic blood endotoxin concentrations were observed only in the external drainage group after oral endotoxin administration. The relief of biliary obstruction effectively relieved portal endotoxemia. External biliary drainage, however, has the potentially deleterious e ffect of disrupting the intestinal mucosa, which may promote the devel opment of endotoxemia. These findings have implications for the use of biliary drainage procedures to reduce postoperative complications in jaundiced patients.