Bacterial translocation in surgical patients
Recent years have seen an increasing recognition of the fact that the gastrointestinal tract has functions other than simply the digestion and excretion of foodstuffs. The gut is also a metabolic and immunological organ that serves as a barrier against living organisms and antigens within its lumen. This role is termed 'gut barrier function.' The fact that luminal contents in the caecum have a bacterial concentration of the order of 10 organisms/ml of faeces, whilst portal blood and mesenteric lymph nodes are usually sterile, dramatically illustrates the efficacy of this barrier function.
The idea that the alimentary tract, teeming with its own bacterial flora, could represent a source of sepsis under certain conditions has interested clinicians for many years. This theory , usually referred to as the 'gut origin of sepsis' hypothesis, is not new. In the late 19th century, the idea evolved that peritonitis could result from the passage of bacteria from organs adjacent to the peritoneal cavity. In Germany this was referred to as durchwanderungs-peritonitis, literally translated as 'wandering through peritonitis.' In 1891 and 1895, two seperate investigators hypothesised that viable bacteria could pass through the intact gut wall in vivo. It was Berg and Garlington in 1979 who defined this phenomenon as 'bacterial translocation.'
'Translocation ' is used to describe the passage of viable resident bacteria from the gastrointestinal tract to normally sterile tissues such as the mesenteric lymph nodes and other internal organs. The term also applies to the passage of inert particles and other macromolecules, such as lipopolysaccharide endotoxins, across the intestinal mucosal barrier.
