Prompt colonization of the hepaticojejunostomy and translocation of bacteria to liver after bile duct reconstruction

Background/Purpose: Ascending cholangitis is one of the most common and earliest complications after bile duct reconstruction (BDR), particularly in patients with biliary atresia. To elucidate if the local factors such as the hepaticojejunostomy (HPJ) was responsible for the infection and the level of HPJ would affect the incidence of bacterial translocation (BT) to liver, this study was conducted. Methods: Fourteen piglets received BDR 2 weeks after ligation of the common bile duct (CBDL). They were further divided into two groups according to the level of HPJ: group 1 (n = 8), at the common hepatic duct and group 2 (n = 6), at the bifurcation. One week after BDR, all the animals were killed. The liver and HPJ were harvested for quantitative tissue culture and for histological study. Results: All HPJ were heavily colonized with at least one, mostly about two to four types of bacteria with a range of the quantitative bacterial growth from 3.9 x 10⁴ to 8.6 x 10⁹ colony- forming units (CFU)/g and a median of 8.3 x 10⁶ CFU/g. Positive BT to liver, defined by more than 1 x 10² CFU/g, was found in 0 of the 14 piglets on day 1, 4 of 14 (29%) after CBDL, but in 9 of 14 (64%) after BDR (P = .001). Eight of the nine animals with positive BT to liver have the same species of bacteria found in their corresponding HPJ. Incidence of BT to liver was four of eight (50%) in group 1 and five of six (83%) in group 2, which was not significantly different (p = .30). Conclusions: This study suggests that there is prompt colonization of HPJ 1 week after BDR, which is in turn an important local factor responsible for BT to liver. The level of HPJ does not affect the incidence of BT to liver.