Bacteria ascend to liver from the bilioenteric conduit after choledochojejunostomy in the cholestatic rat.

Abstract

The high incidence of postoperative cholangitis in children with clinical restoration of bile flow after Roux-Y choledochojejunostomy (RYCJ) assumed the concept of a direct ascending cholangitis caused by pathogens in the intestine, into the intrahepatic bile duct via the porta hepatis. It is also well known that jaundiced animals (patients) are more susceptible to infections of the bile ducts following the procedure of bilioenteric anastomosis. An animal experiment was conducted to compare quantitative bacterial cultures of the choledochojejunostomy area and the liver 24 hours after Escherichia coli (ATCC 25922) or sterile normal saline was injected into the bilioenteric conduit (BEC), following RYCJ in rats with or without the proceeding bile duct ligation. A significant increase of E. coli of the same strain (ATCC 25922), that we injected into the BEC, was proved with pulse-field gel electrophoresis (PFGE) and shown in the liver of the jaundiced rats receiving E. coli (ATCC 25922), compared to that in the nonjaundiced rats with normal saline treatment. It is concluded that bacteria often ascend early to the liver from the BEC following RYCJ. This ascending cholangitis model might be produced for further studies.