The influence of abdominal sepsis on acute pancreatitis in rats: a study on mortality, permeability, arterial pressure, and intestinal blood flow.

Bacterial infection increases mortality and morbidity in acute pancreatitis. The aim of the present study was to analyze possible mechanisms by which bacterial infectious complications may worsen the course of the disease. Systemic arterial pressure, mucosal microcirculation, and intestinal, peritoneal, and pulmonary permeability of 125I-labeled human serum albumin were measured 3, 6, 12, 24, 48, and 72 h after sham operation, induction of pancreatitis (AP), abdominal sepsis (AS), or AP+AS. The mortality rate at 48 and 72 h was 33% in AS and 58 and 75%, respectively, in AP+AS, whereas there were no deaths in the AP or sham-operated groups. The systemic arterial pressure and intestinal blood flow decreased early in all study groups, with the lowest values for AP+AS. Bacterial infection aggravated the increase in intestinal, peritoneal, and pulmonary permeability to labeled albumin in pancreatitis. This was true for both intestinal endothelial permeability (blood to tissue) and mucosal barrier permeability (blood to lumen). The findings demonstrate the occurrence of circulatory failure and changes of the capillary barrier in multiple organs in acute pancreatitis. Moreover, the changes were aggravated by an intraabdominal septic challenge. The observations imply that bacterial infection may play a role in the development of multiple organ failure in acute pancreatitis, tentatively by aggravating alterations in tissue barrier function.