BACTERIAL TRANSLOCATION FROM THE BILIARY-TRACT TO BLOOD AND LYMPH IN RATS WITH OBSTRUCTIVE-JAUNDICE

Background. The disruption of the hepatocyte tight junctions observed in biliary obstruction suggests altered permeability of the blood-bile barrier. In this study the role of biliary obstruction and increased biliary pressure on the translocation of bacteria from biliary tract t o bloodstream and lymphatic system were evaluated. Materials and Metho ds. Rats underwent distal bile duct ligation (BDL, n = 33) for two wee ks or a sham celiotomy (n = 21). Seventeen of the 33 BDL rats underwen t subsequent biliary decompression by a choledochojejunostomy (CJ). Tw o weeks after the final operation, a laparotomy was performed again an d the CBD, the thoracic duct, and the caval vein were canulated. Next, a suspension containing 10(8) Escherichia coli/ml was retrogradely in fused in the CBD for 5 min at 5 or 20 cm H2O above the secretory bilia ry pressure. Results. A higher biliary infusion pressure resulted in a significant increase of cfu E. coli per milliliter of blood in all th e three groups (Sham, BDL, CJ). BDL rats showed significantly more bac terial translocation to the bloodstream than the shams. After biliary decompression, translocation normalized to the control levels. At 5 cm H2O infusion pressure only one lymph culture was positive (CJ group). At 20 cm H2O overpressure, nine lymph cultures were E. coli positive (P = 0.03). These were found mainly in groups with a nonobstructed bil e duct (Sham and CJ 40% vs BDL 10%). Conclusion. Translocation of bact eria from biliary tract to bloodstream increased at higher intrabiliar y pressures. Longstanding bile duct obstruction was an independent det erminant for cholangiovenous reflux. Bacterial translocation to the ly mphatic system did not parallel translocation to the bloodstream, alth ough in the nonobstructed biliary tract, increased bacterial transloca tion to the lymphatic system was pressure related. (C) 1998 Academic P ress.