Influence of SDD and caecostomy/colonic irrigation on gut endotoxin/bacteria translocation following acute severe pancreatitis

AIM: To observe the influence of the selective decontamination of the digestive tract (SDD) and caecosomy/colonic irrigation on gut endotoxin/bacteria translocation following acute severe pancreatitis (ASP). METHODS: Twenty three pigs weighing 16-22 kg were divided into four groups. Group I (n=5): sham-control; Group Ⅱ (n=6): ASP-control; Group Ⅲ (n=6): gntamicin [(8.55×10~5±5.70×10~4) units/time] and nystatin [(1.37×10~5±9.00×10~3) units/time] were fed orally every 8 h for 1 week before the induction of ASP; Group Ⅳ (n=6): caecostomy was performed before the induction of ASP. ASP was induced by infecting 1 mL/kg BW of combined solution of 5% sodium taurocholate and (8-10)×10~6 BAEE units/L of trypsin into pancreas via pancreatic duct. Systemic plasma endotoxin levels were quantified by the chromogenic limulus amebocyte lysate (LAL) technique. Specimens of tissue from mesenteriolum and mesocolon lymph nodes, lung, lymph nodes in hilus pulmonis, pancreas and the samples of both portal and systemic blood were collected before and at 72 h following ASP and cultured for aerobic as well as anaerobic bacteria growth. Positive specimens were subcultured and the bacteria identified by standard procedure. RESULTS: Preventive SDD not only effectively reduced the amount of bacteria in stool (P0.01), but also significantly reduced the levels of plasma endotoxin and the magnitude of bacteria translocation to the portal and systemic blood and the remote organs and tissues, for instance, mesenteriolum and mesocolon lymph nodes, lung, lymph nodes in hilus pulmonis, pancreas. Early caecostomy/colonic irrigation also significantly reduced the levels of translocated origin-endotoxin and bacteria after ASP. CONCLUSIONS: SDD and caecostomy/colonic irrigation effectively reduce the levels of plasma endotoxin and the magnitude of bacteria translocation to the portal and systemic blood and the remote organ, especially the latter will be of a great importance in the future clinical practice. [