Changes in Bacterial Concentration in the Liver Correlate with That in the Hepaticojejunostomy after Bile Duct Reconstruction: Implication in the Pathogenesis of Postoperative Cholangitis

Abstract

Postoperative cholangitis is a frequent and unpredictable complication of unknown etiology following bile duct reconstruction (BDR), particularly for biliary atresia. This study was undertaken to correlate the growth of bacteria in the hepaticojejunostomy with that in the liver after BDR. Quantitative bacterial culture was done on the specimens taken from the liver and from the hepaticojejunostomy at 1 week (group 1, n = 7), 1 month (group 2, n = 7), and 2 months (group 3, n = 7) following BDR with Roux-en-Y hepaticojejunostomy in piglets after 2 weeks of common bile duct ligation. The histological examination of the liver and the hepaticojejunostomy, as well as serial monitoring of hemogram and liver function tests, were performed to correlate the findings with the bacterial concentration of the liver and the hepaticojejunostomy following BDR. The bacterial concentration of the hepaticojejunostomy, expressed as log10 colony-forming units per gram (log10 CFU/g) of the hepaticojejunostomy, showed a progressive decrease from 8.38 +/- 1.36 in group 1, 7.07 +/- 2.54 in group 2, to 3.56 +/- 1.31 in group 3 (p = 0.001). The log10 CFU/g of the liver also showed a progressive decrease from 5.02 +/- 1.59 in group 1, 3.16 +/- 1.56 in group 2, to 2.19 +/- 1.09 in group 3 (p = 0.006). There was a significant positive correlation of the log10 CFU/g of the liver (n = 21) with that of the hepaticojejunostomy (n = 21) following BDR (r = 0.600, p = 0.004). Most of the infectious pathogens isolated from the liver were also isolated from the hepaticojejunostomy. The changes in hemoglobin, bilirubin, albumin, and ammonia significantly correlated with the changes of the bacterial concentration of the liver. The results of the study suggests that hepatic bacterial proliferation after BDR is significantly affected by microbial overgrowth in the bilioenteric anastomosis and is associated with deteriorated liver function and hemogram.

Influence of biliary anastomosis on recovery from secondary biliary cirrhosis

“…In addition to the contamination of the bile with multiple gramnegative bacteria (normally found in biliary infections), a mixed inflammatory infiltrate of variable intensity was found in the animals treated with biliary anastomosis. These findings reinforce the possibility of ascending contamination of the biliary duct as a cause of cholangitis after biliary anastomosis [47][48][49][50]. These alterations can explain the increase in ALP, hypoalbuminemia, and ALT, in addition to explaining the increased number of stellate Incidence of bacterial contamination of the biliary ducts and frequency of bacterial species found in animals in the SO, BO, CD, and CJ groups.…”

Cholestasis downregulate hepcidin expression through inhibiting IL-6-induced phosphorylation of signal transducer and activator of transcription 3 signaling

“…1 Many factors are responsible for deterioration of the liver in BA even after a successful Kasai's procedure (KP), which may include impaired reticuloendothelial system to clear the translocated bacteria and endotoxin from the intestine. 2 Even in patients of benign biliary obstruction 3 and in animals with bile duct ligation (BDL), [4][5] there are still more bacterial overgrowth in the liver and the bile, but the underlying mechanism is still unknown.…”

Serum bacterial DNA detection in patients with cholangitis after Kasai procedure

“…3 Although the reasons for post-operation infection remain debatable, experimental evidence supports the hypothesis of bacterial translocation (BT) from the enteric conduit as the main pathogenic mechanism. 4,5 Reduced lymph drainage at the porta hepatis and insufficient volume of bile flow from a partially obstructed biliary tree are possible causative factors for BT.…”