IMPAIRED HEPATIC BACTERIAL CLEARANCE IS REVERSED BY SURGICAL RELIEF OF OBSTRUCTIVE-JAUNDICE

Sepsis is a major cause of morbidity and mortality in infants with cholestatic jaundice. Previous studies have shown that biliary obstruction in rats causes a significant decrease in hepatic phagocytosis of viable Escherichia coli. This study tests this hypothesis and further evaluates whether the impaired function of the reticuloendothelial system of the liver (Kupffer cells) can be reversed by the relief of the biliary obstruction. Male Sprague-Dawley rats (weighing 140 to 150 g) were placed in three groups. Group I (n = 10) consisted of sham-operated controls. In Group II (n = 30), ligation and division of distal common bile duct (CDL) was performed. Group III (n = 30) underwent choledochoduodenostomy 2 weeks following ligation and division of common bile duct. At 1, 2, and 3 weeks following the operation, 109 35S-radiolabeled viable E coli were injected intravenously via the tail vein. At 10 minutes, bacterial distribution in the liver, spleen, kidneys, and lungs was determined. Tissue samples (50 to 100 mg) from each organ were processed for liquid scintillation counting. The final distribution of bacteria was calculated from the input specific activity (dpm/bacteria) and expressed as the mean percentage of injected viable E coli per gram of tissue and per total organ weight. There was a significant decrease in the trapping of bacteria by the liver's Kupffer cells in rats in group II, at 2 and 3 weeks following CDL (45.0% ± 14.0% and 15.1% ± 4.9%, respectively, v controls 75.9% ± 13.7%; P < .005). This was partially compensated for by an increase of bacterial trapping by the lung (16.8% ± 5.1% and 62.3% ± 7.3%, respectively, v control 1.6% ± 0.8%; P < .005). A complete reversal of hepatic phagocytic dysfunction was observed 2 weeks following the relief of biliary obstruction by choledochoduodenostomy (group III): normal localization of bacteria in the liver (72.1% ± 8.4%) and the lungs (2.94% ± 0.8%) were observed. These data confirm that biliary obstruction results in significant hepatic phagocytic dysfunction. Internal biliary drainage restores normal bacterial clearance and may decrease the susceptibility to morbid infection noted in instances of biliary obstruction. © 1991.