title: Bacterial translocation and infected pancreatic necrosis in acute necrotizing pancreatitis derives from small bowel rather than from colon.
abstract: BACKGROUND
  The clinical course of acute necrotizing pancreatitis (ANP) is determined by the superinfection of pancreatic necrosis. To date, the pathophysiology of the underlying bacterial translocation is poorly understood. The present study investigated the bacterial source of translocation.
  
  
  METHODS
  A terminal loop ileostomy was applied in rats. Selective digestive decontamination (SDD) of either the small bowel or the colon was performed. After 3 days of SDD, severe ANP was induced. At 24 hours, bacterial translocation was assessed by cultures of bowel mucosa, mesenteric lymph nodes, and pancreas using a scoring system (0-4).
  
  
  RESULTS
  Without SDD, pancreatic infection was present in all cases with an average score of 2.67. Colon SDD reduced pancreatic superinfection to 1.67 (not significant). SDD of the small bowel significantly reduced superinfection to 1.0 (P < .005).
  
  
  CONCLUSIONS
  Bacterial translocation from the colon is less frequent than translocation from the small bowel. Thus, the small bowel seems to be the major source of enteral bacteria in infected pancreatic necrosis.
authors.affiliation: Department of General and Visceral Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Fritz
authors.forename: Thilo
authors.initials: T
authors.lastname: Hackert
authors.forename: Werner
authors.initials: W
authors.lastname: Hartwig
authors.forename: Florian
authors.initials: F
authors.lastname: Rossmanith
authors.forename: Oliver
authors.initials: O
authors.lastname: Strobel
authors.forename: Lutz
authors.initials: L
authors.lastname: Schneider
authors.forename: Katja
authors.initials: K
authors.lastname: Will-Schweiger
authors.forename: Mechthild
authors.initials: M
authors.lastname: Kommerell
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D018988:Bacterial Translocation / Q000502:physiology*; D003106:Colon / Q000382:microbiology*; D015169:Colony Count, Microbial; D003666:Decontamination; D004195:Disease Models, Animal; D006090:Gram-Negative Bacteria / Q000502:physiology*; D006094:Gram-Positive Bacteria / Q000502:physiology*; D007081:Ileostomy; D007421:Intestine, Small / Q000382:microbiology*; D008297:Male; D019283:Pancreatitis, Acute Necrotizing / Q000382:microbiology* / Q000473:pathology / Q000517:prevention & control; D051381:Rats; D017208:Rats, Wistar
chemical_list: D000900:Anti-Bacterial Agents