Bacterial Translocation During Portal Clamping for Liver Resection

Ferri, Mario; Gabriel, Sylvie; Gavelli, A; Franconeri, Philippe; Huguet, C

doi:10.1001/archsurg.1997.01430260060013

Cited by 38 publications

(30 citation statements)

References 19 publications

(2 reference statements)

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“…Bacterial translocation has been demonstrated in several experiments and clinical studies in cases of burns [15,16], haemorrhagic shock [17], endotoxaemia [18,19], intestinal obstruction [20], immunosuppression [21], inflammatory bowel disease [22] and total parenteral nutrition [23]. Furthermore, it has been shown that major liver resection and obstructive jaundice induce translocation of enteric bacteria [24][25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Promotion of bacterial translocation by major liver resection in obstructive jaundice in rats colonised predominantly with indigenous Escherichia coli

Narioka

Nishi

Ogata

et al. 2002

Journal of Medical Microbiology

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Section: Introductionmentioning

confidence: 99%

Promotion of bacterial translocation by major liver resection in obstructive jaundice in rats colonised predominantly with indigenous Escherichia coli

Narioka

Nishi

Ogata

et al. 2002

Journal of Medical Microbiology

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“…12 Multiple reviews of the literature have concluded that BT occurs in humans, although its clinical significance has been questioned. 11,13-16 BT has been studied or described in humans in many varied clinical scenarios such as laparotomy, 17,18 emergency and elective surgery, [17][18][19][20] hematologic and colorectal malignancies, 21,22 intestinal obstruction, 23,24 burns, 25 inflammatory bowel disease, 26,27 aortic aneurysm repair, 28 liver resection, 29,30 obstructive jaundice, 31,32 trauma, [33][34][35] pediatric small bowel transplant, 36 and surgical neonates and infants receiving PN, 37 among others. Several of these studies also related BT to increased morbidity, [17][18][19]21,[23][24][25][26]28,29,31,33,34,37 but others did not.…”

Section: Discussionmentioning

confidence: 99%

“…Several of these studies also related BT to increased morbidity, [17][18][19]21,[23][24][25][26]28,29,31,33,34,37 but others did not. 20,22,27,30,32,35,36 A commonly proposed promotional mechanism of BT is physical damage to the barrier function of the intestinal mucosa leading to increased permeability. 13,15,38 A stercoral injury resulting from our patient' s chronic fecal impaction could cause such damage directly, although such injuries are rare and typically seen in elderly, nursing home-dependent, bedridden, or narcotic-dependent patients.…”

Section: Discussionmentioning

confidence: 99%

An Occurrence of Sepsis During Inpatient Fecal Disimpaction

Darrow

Devito

2014

Pediatrics

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Functional constipation is a common pediatric problem that is often treated through well-established algorithms. Fecal disimpaction is the initial therapeutic step, and severe cases require hospitalization for intensive therapies. We describe a significant unexpected complication of this common clinical situation. An 8-year-old boy with suspected chronic functional constipation was hospitalized for disimpaction by continuous nasogastric administration of polyethylene glycol electrolyte (PEG-E) solution. On the sixth day of disimpaction, the patient abruptly developed fever, tachycardia, and tachypnea. Evaluation included blood culture, which grew Escherichia coli, and treatment with a course of appropriate antibiotics was provided. The safety of PEG-E solutions has been shown in studies of children with constipation, which made this patient’s illness surprising. Several potential etiologies of his infection were considered, including bacterial translocation (BT). BT is defined as the passage of live microbes and microbial products from the gastrointestinal tract to extraintestinal sites, such as the bloodstream. It has been shown to occur in a variety of clinical conditions but is of unclear clinical significance. In this case, physical damage to the intestinal mucosa was thought to contribute to the potential occurrence of BT, and prolonged disimpaction was considered as a risk factor. E coli sepsis in a child undergoing inpatient nasogastric fecal disimpaction with PEG-E represents a clinical problem never before reported in the literature and should increase clinicians’ indices of suspicion for uncommon complications of common procedures.

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“…Recently, it has been reported that low level pathogens, including CNS, are able to translocate from the gut to the mesenteric lymph nodes (Ferri et al, 1997), and recent work in infants receiving long-term parenteral nutrition has shown that the bactericidal activity of the blood is initially impaired for CNS, whilst PPM including AGNB are still successfully eliminated (Okada et al, 2000). While systemic immunodysfunction remains moderate the patient develops Gram-positive septicaemias, mainly CNS, and it is only when liver dysfunction and systemic immunosuppression have become more pronounced, that AGNB -apart from their systemic immunosuppressive role -can survive translocation and host defences to make blood cultures positive.…”

Section: Discussionmentioning

confidence: 99%

Gut overgrowth with abnormal flora: the missing link in parenteral nutrition-related sepsis in surgical neonates

et al. 2003

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Background and aims: Patients receiving parenteral nutrition are at risk of septicaemia. Intestinal dysmotility and impaired gut immunity due to parenteral nutrition promote bacterial overgrowth. Gut overgrowth with aerobic Gram-negative bacilli (AGNB) impairs systemic immunity. The aim of this study was to determine the potential role of gut overgrowth with AGNB in the pathogenesis of septicaemia related to parenteral nutrition. Methods: A prospective 5 y study of surgical infants less than 6 months of age was undertaken. Surveillance samples of the oropharynx and gut were obtained at the start of parenteral nutrition and thereafter twice weekly, to detect AGNB carriage. Blood cultures were taken on clinical indication only. Results: Two-hundred and eight infants received parenteral nutrition for 6271 days (median 13 days, range 1 -512 days). The incidence of AGNB carriage was 42%, whilst the septicaemia rate was 15%. Eighty-four percent of septicaemic infants carried AGNB, whilst 16% never carried AGNB (P < 0.005). Carriage developed significantly earlier than septicaemia. Conclusions: The incidence of septicaemia was significantly greater in the subset of abnormal carriers. Although gut overgrowth with abnormal flora reflects illness severity, the fact that it preceded septicaemia implicates AGNB overgrowth, per se, as a contributory factor in the development of septicaemia related to parenteral nutrition. Prevention is unlikely to be successful if it ignores the abnormal flora.

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Bacterial Translocation During Portal Clamping for Liver Resection

Abstract: A significant bacterial translocation in the MLNs occurs after portal triad clamping and liver resection, although not clinically relevant.

Cited by 38 publications

References 19 publications

Promotion of bacterial translocation by major liver resection in obstructive jaundice in rats colonised predominantly with indigenous Escherichia coli

Promotion of bacterial translocation by major liver resection in obstructive jaundice in rats colonised predominantly with indigenous Escherichia coli

An Occurrence of Sepsis During Inpatient Fecal Disimpaction

Gut overgrowth with abnormal flora: the missing link in parenteral nutrition-related sepsis in surgical neonates

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