Evidence for a Coagulopathy Related to Endotoxaemia in Patients with Obstructive Jaundice
Animal studies suggest that endotoxaemia may contribute to tbe disturbances of coagulation in obstructive jaundice. Two groups of patients, 14 controls (C) and 28 jaundiced (J) having pancreatic or biliary surgery were studied prospectively. Endotoxaemia, soluble fibrin (s. f.) by tanned red cell agglutination, FDP and DVT were measured for comparison with outcome of surgery. In group J more complications occurred with 7 deaths and 10 DVT; by comparison, only one death occurred in group C and no DVT, fever or haemorrhage.S. f. was found in none of group C but in 9 of 24 in group J pre-operatively. Presence of s. f. did not influence outcome of surgery. Endotoxaemia and raised FDP were also seen more frequently pre-operatively in group J. Of the group J patients 11 had endotoxaemia or FDP before operation and 7 died. An association between endotoxaemia and FDP was shown in both groups and in group J endotoxaemia appears related to s. f. although s, f. and FDP are independent. A coagulopathy associated with endotoxaemia is present in some jaundiced patients and they fair badly after surgery.