Changes in bacterial concentration in the liver correlate with that in the hepaticojejunostomy after bile duct reconstruction: Implication in the pathogenesis of postoperative cholangitis

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 log(10) colony-forming units per gram (log(10) 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 log(10) 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 log(10) 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.