Bacterial Contamination of the Pancreas with Intestinal Germs: A Cause of Acute Suppurative Pancreatitis?

Hancke, E.; Marklein, G.

doi:10.1007/978-3-642-83027-3_13

Cited by 13 publications

(10 citation statements)

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“…11 ]. Coliform bacteria represent the most frequent patho gens of pancreatitis-associated septic complications, thus suggesting that the colon as a likely source [12][13][14][15], On the other hand. Lange et al [16] have shown that intesti nal lavage combined with kanamycin instillation reduced the mortality in experimental hemorrhagic pancreatitis.…”

Section: Introductionmentioning

confidence: 99%

Bacterial Translocation in the Course of Acute Pancreatitis: Beneficial Role of Nonabsorbable Antibiotics and Lactitol Enemas

Marotta

Geng²,

Wu³

et al. 1996

Digestion

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Two-hundred Wistar rats were allocated to 4 groups. The groups, 3 representing our acute pancreatitis model induced by intrabiliary injection of a trypsin/enterokinase mixture, were studied as follows: (A) no treatment; (B) given a daily 30-ml enema with 20 mg/kg rifaximin; (C) given a daily 30-ml enema with 20 mg/kg rifaximin plus lactitol 0.5 g/kg, and (D) given a daily 30-ml enema with warm saline. A further group of healthy rats was given an intrabiliary injection of 0.15 ml saline. Sacrifices were made after 6,12,24,48 and 72 h of observation. Serial blood samples were drawn to measure pancreatic enzymes and endotoxin. At sacrifice, ascites, lymph nodes, pancreas, spleen, portal vein blood, arterial blood and bile were obtained for bacteriological culture. Both enema treatments brought about a significant improvement in survival. Enema treatments did not affect the serum level of pancreatic enzymes. A time-course increase in endotoxin level was observed in untreated rats. However, significantly decreased levels were observed after both enema treatments. Overall, ascites was the sample most frequently infected. Lymph nodes contiguous to the gut were found to be infected more frequently than those close to major vessels. The histological pancreatic damage was of a significantly lesser degree in both enema treatment groups. Virtually all severe necrotico-hemorrhagic pancreatic lesions were associated with bacterial infection. These data suggest that bacterial translocation plays a relevant role in the outcome of experimental necrotizing pancreatitis. Intra-abdominal spread and lymphatics seem to be the pathways most likely involved in such processes. Colonic cleansing by non-absorbable antibiotics and lactitol seems to exert a beneficial effect on the supervening infection of experimental necrotizing pancreatitis.

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Section: Introductionmentioning

confidence: 99%

Bacterial Translocation in the Course of Acute Pancreatitis: Beneficial Role of Nonabsorbable Antibiotics and Lactitol Enemas

Marotta

Geng²,

Wu³

et al. 1996

Digestion

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“…This may result from the fact that own studies and those by De Waele concerned patients with biliary acute pancreatitis, whilst remaining authors examined bile infection in patients with choledocholithiasis, but without co-existing AP. What might also be mentioned as far as this aspect is concerned, is the fact that during recent years attention is paid to the greater participation of Gram positive bacteria in infecting pancreatic necrosis in the later stage of the disease (23,25,26).…”

Section: Discussionmentioning

confidence: 99%

“…Experiments on animals proved that infected bile may be the factor initiating acute pancreatitis, especially with congestion by deposit in papilla of Vater, with co-existing pressure increase within the lumen of pancreatic ducts (11,20,21), and it is the possible source of expanding infection within the area of infl ammatory-changed pancreas (22)(23)(24)(25)(26). Lack of data concerning bile infection in patients with cholelithiasis and co-existing acute pancreatitis.…”

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confidence: 99%

Bile Infection and Bile Acids Concentration in Bile in Acute Biliary Pancreatitis

Zasada¹,

Panek²,

Dolecki³

et al. 2009

Polish Journal of Surgery

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Biliary stones are the most common etiology of acute pancretitis (AP). Pathomechanism of this etiology is based on common channel theory of Opie. Material and methods. 113 patients with ABP were included in the study -91 with mild and 22 with severe form of ABP. 17 patients with cholelithiasis and choledocholithiasis without ABP served as controls. All the patients were submitted to the same model of treatment. Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sfi ncterotomy (ES) were performed in the day of admission and laparoscopic cholecystectomy within the next 24 hours. Bile specimens were taken from main bile duct (MBD) during ERCP and from gall-bladder (GB) during laparoscopic cholecystectomy. Bacteriological cultures, bile acids (BA) concentration and total and secretory form of IgA concentration were assessed in particular groups of patients. Results. No signifi cant statistical differences of bile infection in MBD and GB were found between the analyzed groups of patients. Furthermore, the bile among the patients with severe ABP was more frequently infected, particularly when obtained from gall-bladder. Most common pathogens found in cultures were Gram negative bacteria. Interestingly, Gram positive cultures and fungi were also signifi cant. The number of species of pathogens was of no signifi cance for infection concerning both: source of bile and groups of patients. Mean concentrations of total BA were different between study groups of patients in MBD and in GB. It is worth mentioning, that the fraction of hydrophobic, secondary BA which are potentially more toxic, was increased in total concentration of BA in MBD particularly in patients with severe form of AP. Among patients with mild AP and controls these values were lower and similar. Conclusions. It seems that BA play as an aggressive factor during AP while in physiologic condition have a protective, antibacterial meaning.

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“…Progressive autodigestion may lead to pancreatic necrosis, and in turn to secondary infection. Increased gut permeability facilitates bacterial translocation from the gut lumen into the blood with secondary infection of pancreatic necrosis [13,14]. Infected necrosis can give rise to overwhelming sepsis, continued amplification of the SIRS, and multiorgan failure in a continuous detrimental spiral.…”

Section: Pathophysiology Of Acute Pancreatitismentioning

confidence: 99%

Nutritional management of acute pancreatitis

Fang

DiSario

2002

Curr Gastroenterol Rep

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Most patients with acute pancreatitis have mild to moderate disease and require no specialized nutritional support. Twenty percent to 30% have severe cases, resulting in a catabolic hypermetabolic state, and these patients may require early aggressive nutritional support. Traditionally, this support has been in the form of total parenteral nutrition. However, recent data suggest that enteral nutrition infused into the jejunum is feasible, well tolerated, associated with fewer complications, and significantly less expensive than parenteral nutrition. The pathophysiology of gut function in acute pancreatitis and the rationale and evidence for parenteral and enteral nutritional support are reviewed herein. An algorithm on the nutritional management of acute pancreatitis is suggested.

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Bacterial Contamination of the Pancreas with Intestinal Germs: A Cause of Acute Suppurative Pancreatitis?

Cited by 13 publications

References 1 publication

Bacterial Translocation in the Course of Acute Pancreatitis: Beneficial Role of Nonabsorbable Antibiotics and Lactitol Enemas

Bacterial Translocation in the Course of Acute Pancreatitis: Beneficial Role of Nonabsorbable Antibiotics and Lactitol Enemas

Bile Infection and Bile Acids Concentration in Bile in Acute Biliary Pancreatitis

Nutritional management of acute pancreatitis

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