The intestine: a central organ in the pathogenesis of septic complications in acute pancreatitis

Despite the array of new diagnostic and therapeutic tools, acute pancreatitis remains a critical condition with a high rate of septic morbidity and mortality. To date the main cause of death is still the occurrence of septic complications. In 80% the cases, the microorganisms responsible for infection are of enteric origin and in 30% of the patients with septic shock, no evident focus of infection is recognized. Bacterial translocation is increasingly accepted as the main cause of infection, sepsis and multiple organ failure in these critically ill patients. The mechanisms facilitating the loss of gut barrier function are overgrowth of enteric bacteria and damage to the intestinal mucosa. Pancreatitis-induced immunosuppression may allow the systemic spread of translocated organisms and subsequent severe septic sequelae.