Obstructive jaundice promotes bacterial translocation in humans.
OBJECTIVE
Significant bacterial translocation was demonstrated following experimental biliary obstruction, however very little is known about the importance and the prevalence of gut-origin sepsis in obstructive jaundice patients. Therefore, the aim of this study was to investigate the concept of gut-origin sepsis in obstructive jaundiced patients and its clinical importance.


METHODS
Twenty-one patients requiring laparotomy for obstructive jaundice (group I) and thirty patients operated on electively mainly for chronic cholecystitis (group II) were studied. Peritoneal swab, mesenteric lymph node, portal venous blood, liver wedge biopsy and bile were sampled for culture immediately after opening the peritoneum. Additionally, peripheral blood samples were taken pre- and post-operatively from all patients. Post-operatively, patients were monitored for infectious complications.


RESULTS
The mean serum bilirubin concentration, gamma glutamyl transferase and alkaline phosphatase levels in jaundiced patients before therapeutic intervention were significantly higher than in control patients. Five patients 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 three patients, but only in two with bacterial translocation in group I. There was one patient with bacterial translocation who had septic complication in group II.


CONCLUSIONS
The present study demonstrated that obstructive jaundice significantly promotes bacterial translocation in humans, however, its clinical importance has yet to be defined.
Kuzu
M A
MA
First Department of Surgery, Ankara Numune Hospital, Turkey. ikuzu@hitit.ato.org.tr
Kale
I T
IT
Cöl
C
C
Tekeli
A
A
Tanik
A
A
Köksoy
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D001419:Bacteria / Q000302:isolation & purification; D018988:Bacterial Translocation; D001646:Bile / Q000382:microbiology; D001663:Bilirubin / Q000097:blood; D002761:Cholangitis / Q000382:microbiology / Q000601:surgery; D002764:Cholecystitis / Q000382:microbiology / Q000601:surgery; D002779:Cholestasis / Q000097:blood / Q000382:microbiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D018805:Sepsis / Q000209:etiology / Q000382:microbiology; D005723:gamma-Glutamyltransferase / Q000097:blood
D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase; D001663:Bilirubin