Major liver resection for hilar cholangiocarcinoma.

Between 1968 and 1984 liver resection with curative attempt was performed in 22 patients with hilar cholangiocarcinoma. Right lobectomy was performed in 4 patients, extended right lobectomy in 7, left lobectomy in 8, and excision of the median segment segment of the left lobe (segment IV) in 3. Bilio-enteric continuity was restored by hepatocholedochostomy in 17 patients and hepatojejunostomy in 4. (One patient had external transhepatic catheter drainage and no internal bile drainage.) Operative mortality rate was 27% and caused by excessive intraoperative bleeding, sepsis, or liver insufficiency. Postoperative complications occurred in 57% of patients surviving the operation and were due mainly to leakage from the hepatocholedochostomy. Median survival was 6 months, and one third of the patients survived 1 year. Three patients survived 10 years and were among the four patients in whom a tumor-free resection margin was obtained (one of them died in the postoperative phase). It is concluded that resection of hilar cholangiocarcinoma may give long-term survival if a free resection margin is obtained. The importance of a free resection margin indicates that surgery should be aggressive and include liver resection.

A rat model for sepsis in chronic biliary obstruction.

The effect of retrograde intrabiliary (RI) injection of E. coli was studied in Sprague-Dawley rats with and without chronic biliary obstruction. The challenge dose of E. coli was standardized by the use of frozen (-80 degrees C) aliquots of bacteria. Injection of 10(2), 10(5) or 10(8) colony-forming units (CFU), respectively, into three groups of 8 normal rats, immediately after occlusion of the common bile duct (CBD), did not kill any of the animals. In contrast, 5 of 8 animals with chronic biliary obstruction died from E. coli sepsis after RI injection of 10(2) bacteria (p less than 0.05). Furthermore, all of 4 obstructed animals died after challenge with 10(5) CFU (p less than 0.01), as compared to the 8 normal rats surviving this dose. Intraperitoneal injection of 10(5) E. coli did not kill any of 6 animals with 3 weeks biliary obstruction. It is concluded that chronic biliary obstruction and RI injection are prerequisites for the occurrence of lethal septicemia in the animals. The model might be suitable for the study of biliary sepsis in chronic biliary obstruction.

Fatal outcome of splenectomy in rats with experimental biliary infection.

The effect of splenectomy in normal rats receiving retrograde intrabiliary (RI) or intravenous (IV) injection of 10(5) Escherichia coli was studied. IV injection of the bacteria did not cause any deaths, independent of whether simultaneous ligation of the common bile duct was performed or not. In contrast, RI injection immediately after splenectomy resulted in the death of 9/12 animals although only 1/12 RI-injected rats with intact spleens died (p less than 0.005). The findings might have implications for the performance of splenectomy in patients with combined hepato-biliary diseases.

Biliary obstruction and susceptibility to biliary sepsis in rats.

The effect of retrograde intrabiliary (RI) injection of E. coli was studied in Sprague-Dawley rats with biliary obstruction of different duration (3 days; 2, 4, and 6 weeks). By the injection of 10(5) colony-forming units (CFU) immediately after occlusion of the common bile duct (CBD), 15 of 18 normal rats survived without clinical signs of infection. In contrast, six of 11 animals in 3-day obstruction (P = 0.04), seven of 12 in 2-week obstruction (P = 0.02), ten of 12 in both 4-week and 6-week obstruction (P = 0.0004) died of E. coli sepsis after injection of the same amount of bacteria. Animals with longstanding jaundice (4 and 6 weeks) were more susceptible than those with a shorter duration of jaundice (3 days and 2 weeks, P = 0.04). The results warrant the early decompression of the biliary tract in biliary obstruction.

Impaired liver clearance of bacteria in rats with chronic biliary obstruction.

125I-labeled E. coli was injected into the biliary tree of normal rats and rats with 3 weeks' obstruction of the common bile duct to investigate the liver clearance capacity for bacteria. Bile was collected during 15 min, immediately, 1 h, 4 h, or 24 h after the injection. Tissue specimens from the liver, lungs, spleen and kidneys, and blood and urine specimens were collected simultaneously. In normal rats, 40% of the bacteria was recovered in the bile immediately after the injection, whereas 30% was already trapped in the liver. Incubation of the bacteria in the bile duct for 1h, 4h, and 24h resulted in liver retentions of 43%, 15%, and 4%, respectively. The recovery in the bile was 13% after 1-h incubation, and further prolongation of the incubation did not result in a significant decrease. In contrast to these findings, 70% of the injected bacteria was retained in the biliary tree in rats with chronic biliary obstruction (P less than 0.05) as compared to normal rats) and only 1% was trapped in the liver (P less than 0.005) 15 min after injection. One-hour incubation of bacteria in the bile duct decreased the retention in the bile to 30%, but the retention in the liver increased only slightly in these animals. Four and 24 h after injection less than 30% of the bacteria was retained in the hepato-biliary system. Most of these animals showed almost no radioactivity exceeding the background count in the blood, urine, spleen, lungs, and kidneys 15 min after injection.(ABSTRACT TRUNCATED AT 250 WORDS)

Decreased clearance of Escherichia coli from the bile in rats with obstructive jaundice.

Clearance of Escherichia coli from the bile was studied in 4 normal Sprague-Dawley rats and 4 rats with 3 weeks of obstruction of the common bile duct. 125I-radiolabelled heat-killed E. coli were injected into the common bile duct and the radioactivity of the bile monitored for 2 h. The radioactivity declined exponentially during the first 10 min. Bile samples collected from 2 to 15 min after injection showed higher amounts of radioactivity in all rats with biliary obstruction than in the normal rats. However, the clearance rate was higher in normal than in obstructed rats (p less than 0.05). It was, therefore, concluded that the bacteria were cleared off the bile rapidly in normal rats by the function of a liver and/or a biliary tree. The present data, concerning the kinetic study of bacterial clearance from the biliary tract, indicates that the impaired clearance of bacteria in chronic biliary obstruction might be crucial for the development of biliary sepsis.