Bacterial translocation in an experimental intestinal obstruction model. C-reactive protein reliability?
BACKGROUND
Bacterial translocation occurs in preseptic conditions such as intestinal obstruction through unclear mechanism. The C-reactive protein is an acute phase reactant and a marker of ischemia.


METHODS
45 albino male rats were divided into 3 groups each 15 rats. GI control, GII simple intestinal-obstruction and GIII strangulated obstruction. Outcome measures were: (1) Bacteriologic count and typing for intestinal contents, intestinal wall, liver, mesenteric lymph nodes and blood (cardiac and portal) (2) Histopathologic: mucosal injury score, inflammatory cell infiltrate in the wall, MLN, liver, (3) Biochemical: serum CRP, IL-10, mucosal stress pattern (glutathione peroxidase-malonyldialdhyde tissue levels).


RESULTS
(1) Intestinal obstruction associates with BT precursors (Bact-overgrowth, mucosal-acidosis, immuno-incomptence), (2) Bacterial translocation (frequency and density) was found higher in strangulated I.O, that was mainly enteric (aerobic and anaerobic) and mostly E.coli, (3) The pathogen commonality supports the gut origin hypothesis but the systemic inflammatory response goes with the cytokine generating one. (4) The CRP median values for GI, II, III were 0.5, 6.9, 8.5 mg/L, for BT +ve 8 mg/L and 0.75 mg/L for BT -ve rats.


CONCLUSIONS
Bacterial translocation occurs bi-directional (systemic-portal) in intestinal obstruction and the resultant inflammatory response pathogenesis is mostly 3 hit model. The CRP is a non selective marker of suspected I.O cases. However, it is a reliable marker of BT, BT density and vascular compromise during I.O.
Department of Surgery, Mansoura Faculty of Medicine, Mansoura University, Egypt. elawadysaleh@yahoo.com
Saleh Ibrahim
SI
El-Awady
Mohammed
M
El-Nagar
Medhat
M
El-Dakar
Mohammed
M
Ragab
Ghada
G
Elnady
D000818:Animals; D018988:Bacterial Translocation; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D004195:Disease Models, Animal; D007249:Inflammation / Q000473:pathology; D007413:Intestinal Mucosa / Q000098:blood supply / Q000382:microbiology; D007415:Intestinal Obstruction / Q000382:microbiology* / Q000473:pathology; D007422:Intestines / Q000098:blood supply* / Q000382:microbiology; D007511:Ischemia / Q000382:microbiology* / Q000473:pathology; D008297:Male; D051381:Rats
D015415:Biomarkers; D002097:C-Reactive Protein