Bacterial translocation from the biliary tract to blood and lymph in XXXX with obstructive jaundice.

@entity2507 @entity354 @entity35 @entity253 @entity526
BACKGROUND: The disruption of the hepatocyte tight junctions observed in @entity253 suggests altered permeability of the blood-bile barrier. In this study the role of @entity253 and increased biliary pressure on the translocation of bacteria from biliary tract to bloodstream and lymphatic system were evaluated. MATERIALS AND METHODS: @entity35 underwent distal bile duct ligation (BDL, n = 33) for two weeks or a sham celiotomy (n = 21). Seventeen of the 33 BDL @entity35 underwent subsequent biliary decompression by a choledochojejunostomy (CJ). Two weeks after the final operation, a laparotomy was performed again and the CBD, the thoracic duct, and the caval vein were canulated. Next, a suspension containing 10(8) @entity526 /ml was retrogradely infused in the CBD for 5 min at 5 or 20 cm @entity2507 above the secretory biliary pressure. RESULTS: A higher biliary infusion pressure resulted in a significant increase of cfu @entity526 per milliliter of blood in all the three groups (Sham, BDL, CJ). BDL @entity35 showed significantly more bacterial translocation to the bloodstream than the shams. After biliary decompression, translocation normalized to the control levels. At 5 cm @entity2507 infusion pressure only one lymph culture was positive (CJ group). At 20 cm @entity2507 overpressure, nine lymph cultures were @entity526 positive (P = 0.03). These were found mainly in groups with a nonobstructed bile duct (Sham and CJ 40% vs BDL 10%). CONCLUSION: Translocation of bacteria from biliary tract to bloodstream increased at higher intrabiliary pressures. Longstanding bile duct obstruction was an independent determinant for @entity354 . Bacterial translocation to the lymphatic system did not parallel translocation to the bloodstream, although in the nonobstructed biliary tract, increased bacterial translocation to the lymphatic system was pressure related.
