Endotoxaemia in Obstructive Jaundice

Surgical procedures in patients with obstructive jaundice are associated with significant morbidity and mortality1. This is due, to a large extent, to the development of postoperative complications such as sepsis, bleeding disorders and renal failure24. Clinical and experimental studies have suggested several aetiological factors for these complications including hypotension, impaired nutritional status, impaired immune function and the presence of potential toxic substances in the circulation such as bilirubin and bile acids1’5’6. However, in recent years, there has been an increasing recognition of the role of circulating endotoxins in the development of complications in obstructive jaundice4’7-9. The focus of this review will be the proposed association between the presence of systemic endotoxaemia in obstructive jaundice and the subsequent development of systemic complications. The experimental and clinical evidence for the existence of portal and systemic endotoxaemia in obstructive jaundice will be reviewed, followed by an outline of the current theory on the origin and mechanisms of development of endotoxaemia. The effects of endotoxaemia in jaundiced animals and patients, and the mechanisms by which these may be produced, will then be reviewed. The recognition of endotoxaemia as a possible cause of complications in obstructive jaundice and other pathological situations has led to the development of a variety of therapeutic strategies, including the use of anti-endotoxin agents, and these will be discussed.