Bacterial translocation in surgical patient

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.