Cholangiographic features of suppurative cholangitis

Abstract

A 32-year-old man developed right upper quadrant RUQ) pain, fever, and jaundice 10 days after laparotomy nd resection of a 3-cm jejunal GI stromal tumor (GIST). Abominal US revealed a dilated common bile duct (CBD), ith biliary sludge as the likely cause for cholangitis. ERCP howed a dilated CBD with irregular ridging or serration f the CBD wall (A). After sphincterotomy, purulent bile nd thick sludge were cleared. A 10F plastic stent was placed o ensure continued adequate drainage. Follow-up ERCP at weeks showed complete resolution of the previous cholngiographic abnormalities (B). A 65-year-old man with fever, jaundice, and RUQ pain, unesponsive to parenteral antibiotics, underwent an emerency ERCP. Cholangiography revealed dilatation and rregular ridging or serration of the CBD wall (C). After phincterotomy, purulent bile as well as small CBD calculi ere cleared from the duct. A double-pigtail 7F stent was nserted for biliary drainage. Repeat ERCP after 6 weeks revealed resolution of the documented bile–duct-wall abnormality; however, a previously unapparent distal CBD stricture was found, and, subsequently, the diagnosis of cholangiocarcinoma was made (D).