Bacterial translocation and infected pancreatic necrosis in acute necrotizing pancreatitis derives from small bowel rather than from colon.
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.
Fritz
Stefan
S
Department of General and Visceral Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany.
Hackert
Thilo
T
Hartwig
Werner
W
Rossmanith
Florian
F
Strobel
Oliver
O
Schneider
Lutz
L
Will-Schweiger
Katja
K
Kommerell
Mechthild
M
Büchler
Markus W
MW
Werner
Jens
J
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
D000900:Anti-Bacterial Agents