Obstructive jaundice promotes bacterial translocation in humans

BACKGROUND/AIMS: Significant bacterial translocation was demonstrated follo wing experimental biliary obstruction, however very little is known about t he importance and the prevalence of gut-origin sepsis in obstructive jaundi ce patients. Therefore, the aim of this study was to investigate the concep t of gut-origin sepsis in obstructive jaundiced patients and its clinical i mportance. METHODOLOGY: Twenty-one patients requiring laparotomy for obstructive jaund ice (group I) and thirty patients operated on electively mainly for chronic cholecystitis (group II) were studied. Peritoneal swab, mesenteric lymph n ode, portal venous blood, liver wedge biopsy and bile were sampled for cult ure immediately after opening the peritoneum. Additionally, peripheral bloo d samples were taken pre- and post-operatively from all patients. Post-oper atively, patients were monitored for infectious complications. RESULTS: The mean serum bilirubin concentration, gamma glutamyl transferase and alkaline phosphatase levels in jaundiced patients before therapeutic i ntervention were significantly higher than in control patients. Five patien ts demonstrated bacterial translocation in group I (24%), whereas only one did so in group II (3.5%, p<0.05). Septic complications were detected in th ree patients, but only in two with bacterial translocation in group I. Ther e was one patient with bacterial translocation who had septic complication in group III CONCLUSIONS: The present study demonstrated that obstructive jaundice signi ficantly promotes bacterial translocation in humans, however, its clinical importance has yet to be defined.