7
Volume 69 May 1976
325
Section of Surgery President A M Desmond FRCS
Meeting 5 November 1975
Bacteria and the Surgeon [Abridged] Mr Peter Sykes (Withington Hospital, West Didsbury, Manchester, M20 8LR)
Small-bowel Microflora in Intestinal Obstruction and Crohn's Disease In health the fasting stomach is usually sterile and a gradient of organisms exists in the small bowel. The jejunum and mid-ileum contain streptococci and lactobacilli in a concentration of 102-104 organisms/ml. Coliforms and the strict anaerobe bacteroides are present in the distal ileum where the concentration reaches 106 organisms/ml. In the colon there is a vast increase in the concentration of organisms and a wide variety of different organisms may be isolated. Gram-negative anaerobes predominate. Bacterial proliferation within the small bowel is prevented normally by a number of factors which are at present incompletely understood (Tabaqchali 1974). These include the effects of gastric acid; intestinal peristalsis, intestinal secretions, immunoglobulins and bacterial interactions. The ileocecal valve prevents contamination of the small bowel with colonic organisms. In most previous studies of the normal and chronically disordered small bowel, samples of small-bowel content have been obtained using long intestinal tubes or peroral capsules, but these methods are not suited to the investigation of patients with acute intestinal disease, e.g. acute intestinal obstruction. An alternative method is to obtain samples by direct needle puncture of the bowel at the time of laparotomy (Sykes et al. 1976). This method has been used to sample the small-bowel microflora of 20 patients with acute small-bowel obstruction, 11 patients with large-bowel obstruction and 12 patients with Crohn's disease. Thirteen patients
undergoing cholecystectomy for gall-stones confined to the gall-bladder were studied for control purposes. The concentration of organisms in the small bowel of cholecystectomy patients in this study was greater than the concentration of organisms recovered from the normal small bowel by other workers (Gorbach et al. 1967). This increase is probably due to infected bile entering the upper intestinal tract as bile has been shown to be infected in a proportion of patients with gallstones. Patients with acute small-bowel obstruction and acute large-bowel obstruction have an increased count of aerobes and anaerobes and the normal gradient of organisms down the small bowel is lost. The anaerobic count in the small bowel reaches 106 organisms/ml in patients with small-bowel obstruction and the anaerobic count in the small bowel reaches 109 organisms/ml in patients with large-bowel obstruction. These changes may contribute to the high morbidity and mortality from sepsis associated with intestinal obstruction, particularly the high risk of anaerobic infections in patients with large-bowel obstruction. Patients with Crohn's diseases have a slight increase in aerobic and anaerobic counts in the small bowel, but the most striking feature is the great increase in the recovery of fungi. Fungi were isolated from 9 of 26 control specimens, and from 13 of 15 specimens from patients with Crohn's disease. REFERENCES Gorbach S L, Plaut A G, Nahas L, Weinstein L, Spanknebel G & Levitan R (1967) Gastroenterology 53, 856-857 Keighley MI R B, Lister D M, Jacobs S I & Giles G R (1974) Surgery 75, 578-583 Sykes P A, Boulter K & Schofield P F (1976) Journal of Metlical Microbiology (in press) Tabaqchali S (1974) In: Infection with Non-Sporing Anaerobic Bacteria. Ed. I Phillips & M Suissman. Chuirchill Livingstone, Edinburgh & London; pp 61-63
Volume 69 May 1976
325
Section of Surgery President A M Desmond FRCS
Meeting 5 November 1975
Bacteria and the Surgeon [Abridged] Mr Peter Sykes (Withington Hospital, West Didsbury, Manchester, M20 8LR)
Small-bowel Microflora in Intestinal Obstruction and Crohn's Disease In health the fasting stomach is usually sterile and a gradient of organisms exists in the small bowel. The jejunum and mid-ileum contain streptococci and lactobacilli in a concentration of 102-104 organisms/ml. Coliforms and the strict anaerobe bacteroides are present in the distal ileum where the concentration reaches 106 organisms/ml. In the colon there is a vast increase in the concentration of organisms and a wide variety of different organisms may be isolated. Gram-negative anaerobes predominate. Bacterial proliferation within the small bowel is prevented normally by a number of factors which are at present incompletely understood (Tabaqchali 1974). These include the effects of gastric acid; intestinal peristalsis, intestinal secretions, immunoglobulins and bacterial interactions. The ileocecal valve prevents contamination of the small bowel with colonic organisms. In most previous studies of the normal and chronically disordered small bowel, samples of small-bowel content have been obtained using long intestinal tubes or peroral capsules, but these methods are not suited to the investigation of patients with acute intestinal disease, e.g. acute intestinal obstruction. An alternative method is to obtain samples by direct needle puncture of the bowel at the time of laparotomy (Sykes et al. 1976). This method has been used to sample the small-bowel microflora of 20 patients with acute small-bowel obstruction, 11 patients with large-bowel obstruction and 12 patients with Crohn's disease. Thirteen patients
undergoing cholecystectomy for gall-stones confined to the gall-bladder were studied for control purposes. The concentration of organisms in the small bowel of cholecystectomy patients in this study was greater than the concentration of organisms recovered from the normal small bowel by other workers (Gorbach et al. 1967). This increase is probably due to infected bile entering the upper intestinal tract as bile has been shown to be infected in a proportion of patients with gallstones. Patients with acute small-bowel obstruction and acute large-bowel obstruction have an increased count of aerobes and anaerobes and the normal gradient of organisms down the small bowel is lost. The anaerobic count in the small bowel reaches 106 organisms/ml in patients with small-bowel obstruction and the anaerobic count in the small bowel reaches 109 organisms/ml in patients with large-bowel obstruction. These changes may contribute to the high morbidity and mortality from sepsis associated with intestinal obstruction, particularly the high risk of anaerobic infections in patients with large-bowel obstruction. Patients with Crohn's diseases have a slight increase in aerobic and anaerobic counts in the small bowel, but the most striking feature is the great increase in the recovery of fungi. Fungi were isolated from 9 of 26 control specimens, and from 13 of 15 specimens from patients with Crohn's disease. REFERENCES Gorbach S L, Plaut A G, Nahas L, Weinstein L, Spanknebel G & Levitan R (1967) Gastroenterology 53, 856-857 Keighley MI R B, Lister D M, Jacobs S I & Giles G R (1974) Surgery 75, 578-583 Sykes P A, Boulter K & Schofield P F (1976) Journal of Metlical Microbiology (in press) Tabaqchali S (1974) In: Infection with Non-Sporing Anaerobic Bacteria. Ed. I Phillips & M Suissman. Chuirchill Livingstone, Edinburgh & London; pp 61-63
