Background/Aims: Bacterial translocation is postulated as a risk factor in the development of a systemic inflammatory response syndrome (SIRS). Research on this topic has focused on the detection of bacteria and endotoxin in blood or mesenteric lymph nodes (MLNs). We investigated whether bacterial translocation occurs beyond the MLNs into the thoracic duct in a setting of ischemia, partial resection and reperfusion of the porcine liver. Methods: A porcine model of severe, extra-intestinal tissue injury, consisting of prolonged hepatic ischemia and reperfusion, in combination with hemihepatectomy, was used (experimental group, n = 5 pigs). To prevent venous congestion of the gut during ischemia, a temporary portal-caval shunt was created. In 5 animals (sham group) a sham portal-caval shunt was constructed while liver ischemia, partial resection and reperfusion were not induced. Thoracic duct lymph, portal blood and systemic blood were collected, and analyzed for the presence of bacteria and endotoxin. Results: In the experimental group, the incidence of bacterial translocation to the thoracic duct was significantly higher during early reperfusion compared to the sham group (5/5 animals versus 1/5 animals, p < 0.05). Conclusion: This study demonstrates bacterial translocation into the thoracic duct. Translocation at this level leads to direct discharge of bacteria and endotoxin into the systemic circulation and therefore, may potentially enhance the development of SIRS.

Berg RD, Garlington AW: Translocation of certain indigenous bacteria from the gastrointestinal tract to the mesenteric lymph nodes and other organs in a gnotobiotic mouse model. Infect Immun 1979;23:403–411.
Bone RC: Immunologic dissonance: A continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS). Ann Intern Med 1996;125:680–687.
Roumen RMH, Hendriks T, Van der Ven-Jongekrijg J, Nieuwenhuijzen GAP, Sauerwein RW, Van der Meer JWM, Goris RJA: Cytokine patterns in patients after major vascular surgery, hemorrhagic shock and severe blunt trauma. Ann Surg 1993;218:769–776.
Waydhas C, Nast-Kolb D, Jochum M, Trupka A, Lenk S, Fritz H, Duswald KH, Schweiberer L: Inflammatory mediators, infection, sepsis, and multiple organ failure after severe trauma. Arch Surg 1992;127:460–467.
Roumen RMH, Redl H, Schlag G, Zilow G, Sandtner W, Koller W, Hendriks T, Goris RJA: Inflammatory mediators in relation to the development of multiple organ failure in patients after severe blunt trauma. Crit Care Med 1995;23:474–480.
Mainous MR, Tso P, Berg RD, Deitch EA: Studies of the route, magnitude, and time course of bacterial translocation in a model of systemic inflammation. Arch Surg 1991;126:33–37.
Bathe OF, Rudston-Brown B, Chow AWC, Phang PT: Gut is not a source of cytokines in a porcine model of endotoxicosis. Surgery 1996;120:522–533.
Olofsson P, Nylander G, Olsson P: Endotoxin transport routes and kinetics in intestinal ischemia. Acta Chir Scand 1985;151:635–639.
Olofsson P, Nylander G, Olsson P: Endotoxin: Routes of transport in experimental peritonitis. Am J Surg 1986;151:443–446.
Olofsson P: Evaluation of the effects of lymph drainage by a thoracic duct fistula in experimental peritonitis. Acta Chir Scand 1988;154:453–459.
Faist E, Baue AE, Dittmer H, Heberer G: Multiple organ failure in polytrauma patients. J Trauma 1983;23:775–787.
Duce AM, Sánchez García M, Barberán MT, Vincent JG: Thoracic duct drainage. Eur J Surg 1996;162:241–242.
Greenfield J, Gottlieb MI: Variations in the terminal portion of the human thoracic duct. Arch Surg 1956;73:953–959.
Van Wagensveld BA, Van Gulik TM, Gabeler EEE, Van der Kleij AJ, Obertop H, Gouma DJ: Intrahepatic tissue pO2 during continuous or intermittent vascular inflow occlusion in a pig liver resection model. Eur Surg Res 1998;30:13–25.
Baron EJ, Pfaller MA, Tenover FC, Yolken RH, Murray PR: Manual of Clinical Microbiology. Washington, ASM Press, 1995.
Sturk A, Joop K, Ten Cate JW, Thomas LLM: Optimalization of a chromogenic assay for endotoxin in blood; in Ten Cate JW, Büller HR, Sturk A, Levin J (eds): Bacterial Endotoxins: Structure, Biomedical Significance and Detection with the Limulus Amebocyte Lysate Test. New York, Liss, 1985, pp 117–136.
Kim YI, Akizuki S, Kawano K, Goto S, Shimada T: FK 506 prevents critical warm ischemia damage to the pig liver and improves hepatic microcirculation. Transplant Proc 1994;26:2384–2387.
Mazziotti A, Bernardi M, Antonini L, Dioguardi FS, Bellusci R, Papa V, Tacconi C, Gasbarrini G, Cavallari A, Possati L: Plasma amino acid patterns in experimental acute hepatic failure: Comparison between hepatectomy and liver devascularization in pigs. Surgery 1981;90:527–534.
Tønnesen K: Experimental liver failure. Acta Chir Scand 1977;143:271–277.
Nordlinger B, Douvin D, Javaudin L, Bloch P, Aranda A, Boschat M, Huguet C: An experimental study of survival after two hours of normothermic hepatic ischemia. Surg Gynecol Obstet 1980;150:859–864.
Gathiram P, Wells MT, Brock-Utne JG, Wessels BC, Gaffin SL: Oral administered nonabsorbable antibiotics prevent endotoxemia in primates following intestinal ischemia. J Surg Res 1988;45:187–193.
Nieuwenhuijzen GAP, Haskel Y, Lu Q, Berg RD, Van Rooijen N, Goris RJA, Deitch EA: Macrophage elimination increases bacterial translocation and gut origin septicemia but attenuates symptoms and mortality rate in a model of systemic inflammation. Ann Surg 1993;218:791–799.
Tokyay R, Zeigler ST, Traber DL, Stothert JC, Loick HM, Heggers JP, Herndon DN: Postburn gastrointestinal vasoconstriction increases bacterial and endotoxin translocation. J Appl Physiol 1993;74:1521–1527.
Kita Y, Sakon M, Yoshida T, Gotoh M, Monden M: Pringle maneuver during hepatic resection induces inflammatory cytokines. Dig Dis Sci 1996;41:2459–2460.
Lemaire LCJM, Van Lanschot JJB, Stoutenbeek CP, Van Deventer SJH, Wells CL, Gouma DJ: Bacterial translocation in multiple organ failure: Cause or epiphenomenon still unproven. Br J Surg 1997;84:1340–1350.
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