Bacterial translocation to the thoracic duct in a setting of ischemia, partial resection and reperfusion of the porcine liver.
OBJECTIVE
Bacterial translocation is postulated as a risk factor in the development of a systemic inflammatory response syndrome (SIRS). Research on this topic has focused on the detection of bacteria and endotoxin in blood or mesenteric lymph nodes (MLNs). We investigated whether bacterial translocation occurs beyond the MLNs into the thoracic duct in a setting of ischemia, partial resection and reperfusion of the porcine liver.


METHODS
A porcine model of severe, extra-intestinal tissue injury, consisting of prolonged hepatic ischemia and reperfusion, in combination with hemihepatectomy, was used (experimental group, n = 5 pigs). To prevent venous congestion of the gut during ischemia, a temporary portal-caval shunt was created. In 5 animals (sham group) a sham portal-caval shunt was constructed while liver ischemia, partial resection and reperfusion were not induced. Thoracic duct lymph, portal blood and systemic blood were collected, and analyzed for the presence of bacteria and endotoxin.


RESULTS
In the experimental group, the incidence of bacterial translocation to the thoracic duct was significantly higher during early reperfusion compared to the sham group (5/5 animals versus 1/5 animals, p < 0.05).


CONCLUSIONS
This study demonstrates bacterial translocation into the thoracic duct. Translocation at this level leads to direct discharge of bacteria and endotoxin into the systemic circulation and therefore, may potentially enhance the development of SIRS.
Lemaire
L C
LC
Department of Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands. L.C.Lemaire@amcuva.nl
van Wagensveld
B A
BA
van Gulik
T M
TM
Dankert
J
J
van Lanschot
J J
JJ
Gouma
D J
DJ
D000818:Animals; D018988:Bacterial Translocation; D004731:Endotoxins / Q000032:analysis; D004926:Escherichia coli / Q000502:physiology*; D005260:Female; D006498:Hepatectomy; D008099:Liver / Q000098:blood supply*; D015427:Reperfusion Injury / Q000382:microbiology*; D013552:Swine; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology*; D013897:Thoracic Duct
D004731:Endotoxins