Acute pancreatitis and bacterial translocation

Infectious complications are the most frequent and severe complications of acute narcotizing pancreatitis (AP) with a mortality rate up to 80%. Althou gh experimental and clinical studies suggest that the microbiologic source of pancreatic infection could be enteric, information in this regard is sca nt. This study evaluated bacterial translocation (BT) using mild and severe models of AP. Mild AP was induced by 6-hr continuous intravenous infusion of cerulein, while severe AP was induced by additional infusion of glycodeo xycholic acid into the biliopancreatic duct. BT was evaluated with organ cu ltures performed when animals were killed (24 hr). To confirm the gastroint estinal origin of the translocating microorganisms, fluorescent microsphere s were also given to the animals in drinking water 24 hr before induction o f AP. At the time of death beads were counted with a (fluorescence-activate d cell sorter) (FACS) in peritoneal lavages and with fluorescent microscopy in frozen sections of the pancreata. Morphology of the distal small bowel showed significant changes in the animals with AP compared to controls, suc h as reduction of villus high and altered microvasculature. Mild AP induced BT to the pancreas in 100% of the animals, compared to pancreata from cont rol groups. Severe AP induced increased BT to the pancreas. BT to liver and spleen was also significantly increased with AP. The presence of fluoresce nt microspheres confirmed their enteric derivation. This study provides evi dence for the enteric origin of microorganisms responsible for pancreatic i nfectious complications during AP. The evidence of BT after laparotomy sugg ests an increased risk of infections with the association of these conditio ns. This could provide an explanation for the high mortality associated wit h laparotomy in course of AP.