Treatment of acute cholangitis caused by benign processes in the major duodenal papilla

Abstract

Objective: to improve the surgical treatment of acute cholangitis caused by benign tumors in the area of the major duodenal papilla.Material and methods. Analysis of the surgical treatment of 83 patients with acute cholangitis arising from benign diseases in the area of the major duodenal papilla was made. Among them, there were 49 men and 34 women. The average age of patients was 49.7 ± 6.9 years. According to the nosological forms, it looked as follows: papillary stenosis — 51, adenomas of the major duodenal papilla — 13, parapapillary duodenal polyps — 12, diverticulum of the duodenum in the area of the major duodenal papilla — 5, peptic duodenal ulcer — 2.Results. Acute cholangitis in papillary stenosis, adenoma of the major duodenal papilla, parapapillary polyps was eliminated using endoscopic transduodenal techniques with the removal of the immediate cause of acute cholangitis. For this used endoscopic papillo-sphincterotomy, endoscopic mechanical lithotripsy, lithoextraction, electroexcision of polyps and adenomas. Among 83 patients, 19 (22,9%) patients had to perform 2 or more endoscopic transpapillary interventions. The greatest difficulties were in the cannulation of the major duodenal papilla in patients with parapapillary ulcers and duodenal diverticulum. Two patients underwent laparoscopic and two patients underwent open surgical interventions. Among 83 patients treated with acute cholangitis on the background of benign pathology of the major duodenal papilla, 11 (13,3%) had different complications. Conclusions. Acute cholangitis in papillary stenosis, adenoma of the major duodenal papilla and parapapillary polyps with concomitant choledocholithiasis can be completely treated exclusively with endoscopic interventions (if necessary — multiple) with a small number of complications (13,3%). Treatment of acute cholangitis on the background of parapapillary ulcers and duodenal diverticulum in most cases requires the use not only endoscopic transduodenal techniques, but also the use of laparoscopic biliary and open resection surgical interventions.