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Obstructed intestine as a reservoir for systemic infection
E A Deitch1, W M Bridges, J W Ma
1Department of Surgery, Louisiana State University Medical Center, Shreveport 71130-3932.
Abstract:
Intestinal motility, absorption, and secretion are altered after intestinal obstruction, but at what point the normal bacterial barrier function of the viable gut fails after intestinal obstruction is unclear. Thus, we tested whether after simple intestinal obstruction bacteria would translocate across the viable intestinal wall to cause systemic infection. Within 6 hours of intestinal ligation 1 cm proximal or distal to the ileocecal valve, bacteria had translocated to the mesenteric lymph nodes, and by 24 hours after intestinal obstruction, bacteria had spread to the liver, spleen, and blood stream. Bacterial translocation rarely occurred in the animals undergoing laparotomy and sham intestinal ligation, indicating that bacterial translocation was not due to surgical stress. Based on the results of these studies, bacterial translocation induced by intestinal obstruction appears to be due to disruption of the ecology of the normal gut microflora, leading to intestinal overgrowth with certain enteric bacilli and mucosal damage. Although the exact mechanism(s) by which simple mechanical obstruction injures the intestine is not known, the fact that mucosal injury did not occur in germ-free mice suggests that bacteria may play a role in the pathogenesis of obstruction-induced intestinal injury.
Insights
Intestinal obstruction causes bacteria to spread from the gut to the bloodstream within 24 hours. This bacterial translocation is linked to gut microflora disruption and potential injury.
Area of Science:
- Gastroenterology
- Microbiology
- Surgical Pathology
Background:
- Intestinal obstruction alters gut function, but the failure of bacterial barrier integrity remains unclear.
- Understanding bacterial translocation is crucial for managing complications of intestinal obstruction.
Purpose of the Study:
- To investigate bacterial translocation across the viable intestinal wall following simple intestinal obstruction.
- To determine the timeline and extent of bacterial spread to systemic organs.
Main Methods:
- Surgical ligation of the intestine in rodents to induce obstruction.
- Monitoring bacterial presence in mesenteric lymph nodes, liver, spleen, and bloodstream over 24 hours.
- Comparison with sham-operated and germ-free animal models.
Main Results:
- Bacterial translocation to mesenteric lymph nodes occurred within 6 hours post-obstruction.
- Systemic spread to liver, spleen, and blood was observed by 24 hours.
- Bacterial translocation was minimal in sham surgeries, ruling out surgical stress as the cause.
Conclusions:
- Intestinal obstruction leads to rapid bacterial translocation, potentially causing systemic infection.
- Disruption of gut microflora and subsequent enteric bacilli overgrowth contribute to translocation and mucosal damage.
- Bacteria may play a role in the pathogenesis of obstruction-induced intestinal injury, as suggested by germ-free mouse studies.