Acute Suppurative Cholangitis Research Articles

Emergency endoscopic intervention in acute obstructive suppurative cholangitis complicated with septic shock

Objective To evaluate the efficacy of emergency endoscopic intervention in acute obstructive suppurative eholangitis （AOSC） complicated with septic shock. Methods A total of 54 patients with AOSC and septic shock who underwent therapeutic emergency ERCP were included in this retrospective study, and were evaluated by the shock index （SI）. Results ERCP was performed for all patients in 24 hours after hospitalization, and the average ERCP operation time was 23.8 ± 12.5 rain. All 54 patients underwent EST, 46 of whom received ENBD, 7 biliary stenting and 1 transferred to surgery due to bleeding. The post-ERCP mortality rate was 0, and the complications included 1 case of pancreatitis and 2 cases of pneumonia. The positive rate of Gram-Negative bacillus before ERCP was 46. 9% （15/32）. The SI before ERCP was 1. 250 ±0. 200, which decreased to 0. 950±0. 119 at 2hr after the procedure （P 〈0. 001 ） , and decreased further to 0. 598 ± 0. 099 （P 〈 0. 001 ） at 24 hours after ERCP. Conclusion Therapeutic emergency ERCP is of great importance in the treatments for AOSC complicated with septic shock. Key words: Cholangitis ; Shock, septic ; Cholangiopancreatography, endoscopic retrograde; Emergency treatment; Shock index

Clinical analysis on 53 patients with acute obstructive suppurative cholangitis

Objective To study the clinical method and therapeutic effects in treatment for acute obstructive suppurative cholangitis.Methods The clinical data of 53 patients with acute obstructive suppurative cholangitis were retrospectively analyzed in our hospital from January 2006 to March 2010.Results 42 patients were accepted operation treatment,satisfied clinical curative effect was obtained,no deaths occurred; 11 patients were accepted conventional treatment,the symptoms included abdominal pain,shock and fever shivers were eased gready,and all of them were accepted operation treatment after the body conditions improved,satisfied clinical curative effect was obtained in all patients.Conclusion Operation treatment is the main method for acute obstructive suppurative cholangitis treatment,it shows satisfied clinical curative effect after the shorter period of therapy,and the symptoms are improved significantly,which include abdominal pain,shock,fever,etc. Key words: Acute obstructive suppurative cholangitis; Operation treatment; Conservative treatment

Endoscopic Nasobiliary Drainage and Percutaneous Transhepatic Biliary Drainage for the Treatment of Acute Obstructive Suppurative Cholangitis: A Retrospective Study of 37 Cases

This study compared the effectiveness and safety of endoscopic nasobiliary drainage(ENBD) to percutaneous transhepatic biliary drainage(PTBD) for the treatment of acute obstructive suppurative cholangitis (AOSC). AOSC patients were assigned to undergo either ENBD (n=22) or PTBD(n=15). In the ENBD group, the procedure was successfully completed in 19 patients (86.4%), where- as it was converted to PTBD in 3 patients (13.6%) due to the failure of antegrade cholangiography. All the patients in the PTBD group underwent first- or second-look PTBD successfully. ENBD is effective for the treatment of AOSC, facilitating subsequent endoscopic or surgical intervention. PTBD is an effective and safe alternative to ENBD in patients unsuitable for ENBD.

Mo1346 Is Endoscopic Sphincterotomy (EST) Unnecessary as an Urgent Treatment for Acute Obstructive Suppurative Cholangitis (AOSC)?

Mo1346 Is Endoscopic Sphincterotomy (EST) Unnecessary as an Urgent Treatment for Acute Obstructive Suppurative Cholangitis (AOSC)?

Right hepatic artery thrombosis in an essential polycythemia vera patient following pancreato-biliary surgery for severe pancreatitis

Hepatic artery thrombosis (HAT) remains one of the major causes of graft failure and mortality in liver transplant recipients. But it is a very rare in non-transplantation patient with the complication of HAT. We reported herein a case of successful urokinase intra-arterial thrombolytic treatment for HAT in an essential polycythemia vera patient following pancreato-biliary surgery. This patient underwent debridement and T-tube drainage in common bile duct for severe pancreatitis and acute suppurative obstructive cholangitis. Significant elevation of liver transaminases and white blood cell counts was noted 30 days after operation and HAT was confirmed by CT-angiography and digital subtracted angiography. Apart from malena and malaise, this patient had scarcity of evident symptoms. The only obvious risk factor relating to HAT is thrombocytosis. This patient was continuously characterized by an excess of platelets from its admission to the onset of HAT. This patient was treated successfully with continuous transcatheter arterial thrombolysis using urokinase. The symptom including malena and malaise disappeared 3 days after thrombolysis. And the patient was treated with hydroxyurea for polycythemia vera thereafter. In conclusion, physicians should be alerted that HAT can be happened in non-transplantation patients especially in those of having hypercoagulability.

Emergency endoscopic intervention versus surgery in the management of acute obstructive suppurative cholangitis

Emergency endoscopic intervention versus surgery in the management of acute obstructive suppurative cholangitis

Severe sepsis caused by Aeromonas hydrophila in a patient using tocilizumab: a case report

IntroductionAeromonas species do not commonly cause disease in humans. However, when disease is seen, it often occurs in patients with underlying immunosuppression or malignancy and has a high fatality rate.Case presentationA 72-year-old Japanese woman with rheumatoid arthritis treated with tocilizumab (which has an immunosuppressive effect) presented with severe epigastric pain. She had a fever with chills, hypotension and jaundice. She was diagnosed with acute suppurative cholangitis and treated with cefoperazone-sulbactam and an endoscopic drainage was performed. Jaundice was slightly improved, but the shock state and inflammatory reactions were prolonged as typical of septic shock. On the second day after admission, an electrocardiogram showed ST segment elevation and echocardiography showed ventricular wall dysfunction. Coronary arteries were patent in coronary angiography and she was diagnosed with stress-induced cardiomyopathy. Blood cultures showed Aeromonas hydrophila. A stool culture was negative for A. hydrophila. On day six, her white blood cell count and neutrophils were normalized and cefoperazone-sulbactam treatment was halted. Left ventricular function normalized on day twelve and a laparoscopic cholecystectomy for cholelithiasis was performed on the 16th day of hospitalization. A culture from the bile showed A. hydrophila. Eighteen days after surgery, tocilizumab treatment was restarted and there were no complications. Two months after restarting tocilizumab, our patient is stable without any serious events.ConclusionWe present a rare case of A. hydrophila sepsis and acute suppurative cholangitis in an elderly patient with gallstones and rheumatoid arthritis using tocilizumab. This clinical course may suggest that preemptive treatment for cholelithiasis prior to using molecular-targeting agents might be feasible in elderly patients.

Imaging of Biliary Tract Disease

W551 disease believed to increase the risk of cholangiocarcinoma [3]. Sclerosing cholangitis often presents with clinical features of biliary obstruction, such as jaundice and pruritus, but usually in the absence of signs of infection. Primary sclerosing cholangitis tends to involve the intrahepatic bile ducts to a greater extent than the extrahepatic ducts. Approximately 15% of patients with primary sclerosing cholangitis develop cholangiocarcinoma [4]. Cholangiocarcinoma is less common than other hepatic and cholecystic malignancies, representing approximately 1% of all malignancies. Most cholangiocarcinomas are adenocarcinomas [5]. Most patients with cholangiocarcinoma present between the sixth and seventh decades of life; however, patients with primary sclerosing cholangitis can develop cholangiocarcinoma at a younger age [5]. The extrahepatic biliary ducts are affected more commonly than the intrahepatic ducts [5]. An increased serum CA19-9 level can also be observed in patients with cholangiocarcinoma, whereas elevated α-fetoprotein levels are associated with hepatocellular carcinoma rather than cholangiocarcinoma [5]. Biliary obstruction is most commonly due to choledocholithiasis. Obstruction may also be a consequence of biliary strictures, malignancy, iatrogenic disease, and parasitic disease [6]. Biliary obstruction precipitates acute suppurative cholangitis by causing hepatovenous reflux and subsequent bacteremia [7]. The organisms most commonly associated with acute suppurative cholangitis include Escherichia coli, Klebsiella species, Proteus species, Bacteroides species, and Pseudomonas aeruginosa [8]. The classic clinical presentation is of right upper quadrant pain, fever, and jaundice (Charcot triad), sometimes with hypotension and altered consciousness (Reynolds pentad) [6, 9]. Acute suppurative cholangitis may lead Imaging of Biliary Tract Disease

急性閉塞性化膿性胆管炎(AOSC)の病態と治療

急性閉塞性化膿性胆管炎(AOSC)の病態と治療

Reports of four cases of acute obstructive suppurative cholangitis without dilation of common bile duct

重症急性胆管炎(ACST)是临床常见的危重病之一.我科自2006年5月至2009年9月共收治重症急性胆管炎66例,其中4例术前未发现胆道扩张及胆道内异物而是术中确诊,具有一定的隐匿性.现将其临床表现、术中所见及术后转归报道如下。

AL amyloidosis with severe gastrointestinal invasion and acute obstructive suppurative cholangitis

AL amyloidosis with severe gastrointestinal invasion and acute obstructive suppurative cholangitis

Acute obstructive suppurative cholangitis as a cause of acute kidney injury and rhabdomyolysis

Acute obstructive suppurative cholangitis as a cause of acute kidney injury and rhabdomyolysis

Observation of the therapy of 47 patients with acute obstructive suppurative cholangitis

Objective To explore the therapeutic method of acute obstructive suppurative cholangitis (AOSC). Methods 47 patients with acute obstructive suppurative cholangitis were collected and the clinical feature,therapy methods and therapy effects were analyzed. Results All the patients were accepted operation.28 patients were cured.The cured rate was 59.6%.16 patients got improvement and the rate was 34.0%.The total effective rate was 93.6%.The therapeutic effect was better.There were 3 patients died because serious septic shock and multiple systemic organ failure. Conclusion The timely and effective operations to remove the obstruction of biliary tract,controls the infection,corrected the shock and prevent and treat complication were the key of reduce the death rate of patients. Key words: Acute,obstructive,suppurative,cholangitis; Therapy

What Are the Risk Factors for Acute Suppurative Cholangitis Caused by Common Bile Duct Stones?

Acute suppurative cholangitis (ASC), a severe form of acute cholangitis, is a life-threatening condition that must be treated with appropriate and timely management. The purpose of this study was to identify the factors that predispose patients to ASC. We retrospectively investigated 181 patients (100 men, 81 women; age, 70.66±7.38 years, mean±SD) who were admitted to Wonkwang University Hospital between January 2005 and June 2007 for acute cholangitis with common bile duct (CBD) stones. All patients underwent endoscopic retrograde cholangiopancreatogram to remove the stones. Variables and factors that could be assessed upon admission were analyzed to identify the risk factors for the development of ASC. Of the 181 patients, 44 (24.3%) presented with ASC. On multivariate analysis, the followings were found to be independent risk factors for the development of ASC: impacted common bile duct stone (p=0.010), current smoker status (p=0.008), advanced age (>70 years; p=0.002), and gallstone (p=0.016). The most commonly isolated organisms in bile culture were Enterococcus species, Escherichia coli, and Klebsiella species. Impacted bile-duct stones, current smoking, advanced age, and gallstones were identified as independent risk factors for the development of ASC in patients with CBD stones. These results suggest that emergency biliary drainage is beneficial in patients with these risk factors.

IS NASOBILIARY DRAINAGE UNNECESSARY FOR DRAINAGE OF ACUTE SUPPURATIVE CHOLANGITIS? OUR EXPERIENCE

Two randomized controlled trials comparing endoscopic nasobiliary drainage (ENBD) and internal endoscopic biliary drainage (internal EBD) for acute suppurative cholangitis (ASC) showed no significant difference in efficacy and both preferred internal EBD to ENBD. In this study, the necessity of ENBD was re-examined. Over five years, 59 patients underwent an emergency endoscopic procedure for ASC in our institute. If drainage was needed, we selected internal EBD as a first choice and ENBD was used in patients predicted to have early obstruction of the tube or retrograde infection of the bile duct. The rate of ENBD, for which reason ENBD was selected, and the efficacy of drainage were examined retrospectively. In the 59 patients, 40 patients had the stones completely removed without drainage, five internal EBD and two ENBD were performed without removal of stones and five internal EBD and seven ENBD were performed after removal of stones. In terms of white blood cell count and direct bilirubin level, no significant difference was observed between ENBD and internal EBD patients. ENBD was mainly selected for the patients with multiple biliary strictures, hemorrhage tendency and excessive purulent bile. Even though internal drainage is suitable in many ASC patients, ENBD is necessary in selected patients.

Clinical effects of intensive insulin therapy on diabetes with acute obstructive suppurative cholangitis in elderly patients

Objective To study the clinical effects of the intensive insulin therapy on diabetes with acute obstructive suppurative cholangitis in elderly patients.Methods Sixty-four patients aged over 70 were divided into two groups:group A(maintenance of blood glucose at a level between 4.4 and 6.1lmmol/L)and group B(maintenance of blood glucose at a level between 10.0 and 11.1mmol/L).Insulin was infused by micro-injection pump.The changes of APACHEII score postoperative complications,average length of stay in hospital and prognosis were observed.Results The average APACHEII score of group A was significantly decreased after 3rd day postoperation(P＜0.01).The average length of stay in hospital of group A was significantly shorter than that of group B(P＜0.05).The postoperative complications of group A were significantly decreased(P＜0.05).Conclusion Intensive insulin therapy contributes to the outcome of the elderly patients with acute obstructive suppurative cholangitis. Key words: Cholangitis; Insulin infusion; Aged

Discrimination of suppurative cholangitis from nonsuppurative cholangitis with computed tomography [CT

Suppurative cholangitis is characterized by obstruction, inflammation, and pyogenic infection of the biliary tract. This disease represents a true emergency. The purpose of this study was to compare the computed tomography (CT) findings between acute calculous suppurative and nonsuppurative cholangitis and to determine whether there are findings that assist in the differential diagnosis.

Abscess of the Round Ligament of the Liver Associated with Acute Obstructive Cholangitis and Septic Thrombosis

A man with abscess of the round ligament of the liver associated with acute obstructive suppurative cholangitis and portal thrombosis is reported. A 63-year-old man was admitted with epigastralgia and high fever. Blood tests showed elevation of hepato-biliary enzymes and coagulopathy consistent with acute obstructive suppurative cholangitis and disseminated intravascular coagulation. Computed tomography revealed a small abscess of the round ligament of the liver and left portal thrombosis. After endoscopic biliary stenting, antibiotics and thrombolytic therapy, the high fever, disseminated intravascular coagulation and portal thrombosis rapidly improved, and the round ligament abscess was also later resolved.

The safety and effectiveness of endoscopic biliary decompression by plastic stent placement in acute suppurative cholangitis compared with nasobiliary drainage

Endoscopic retrograde biliary drainage (ERBD) by using a plastic stent is suggested to be as effective as endoscopic nasobiliary drainage (ENBD) for temporary biliary drainage in acute suppurative cholangitis (ASC). However, there are few studies that compared ERBD and ENBD in ASC. We compared the safety and efficacy of ERBD and ENBD for temporary biliary drainage in patients with ASC. A case series. A tertiary-referral center. Eighty patients with ASC underwent endoscopic biliary drainage with ENBD (n = 41) and ERBD (n = 39). Clinical outcomes, including complications related to ERCP and complications related to the type of the indwelling catheter. Endoscopic biliary drainage was successfully achieved in all patients (100%). There were no significant differences in the demographic data between the 2 groups. There were no differences in the improvement of clinical and laboratory parameters between the 2 groups. Overall ERCP-related complication rates in the ENBD and ERBD groups were 31.7% and 38.5%, respectively (P = .527). Hyperamylasemia occurred in 18 patients, 12.2% in the ENBD group (5/41) and 33.3% in the ERBD group (13/39) (P = .024). Without endoscopic sphincterotomy (EST), there was no statistically significant difference in the incidence of hyperamylasemia between the 2 groups. However, with an EST, hyperamylasemia was more frequent in the ERBD group (12/28 [42.9%]) than in the ENBD group (3/27 [11.1%]) (P = .008). A single-center experience. Endoscopic biliary decompression, whether by ERBD or ENBD, is an effective treatment for patients with ASC. However, more frequent hyperamylasemia with ERBD and EST deserves further evaluation.

Discrimination of suppurative cholangitis from nonsuppurative cholangitis with computed tomography (CT)

Purpose Suppurative cholangitis is characterized by obstruction, inflammation, and pyogenic infection of the biliary tract. This disease represents a true emergency. The purpose of this study was to compare the computed tomography (CT) findings between acute calculous suppurative and nonsuppurative cholangitis and to determine if there are findings that assist in the differential diagnosis. Materials and methods Fifteen patients with acute suppurative cholangitis were enrolled in this study. Findings at endoscopic retrograde cholangiopancreaticography (ERCP) were the standard of reference for suppurative cholangitis. To compare the findings of suppurative cholangitis with those of nonsuppurative cholangitis, 35 patients with nonsuppurative cholangitis were randomly selected. The following findings were evaluated: the presence of papillitis, the presence of stones in the ampulla, the presence of intrahepatic stones, the presence of early inhomogeneous enhancement of the liver, the degree of bile duct dilatation, the degree of bile duct wall thickening and presence of cholecystitis. Sensitivity and specificity for each of the individual findings were calculated. Statistical analyses were performed the Pearson χ 2 test, Fisher's exact test and the Mann–Whitney U test. Results Papillitis showed the highest specificity 86% with 60% sensitivity. Marked inhomogeneous enhancement of the liver during the arterial phase showed 80% specificity with 60% sensitivity. In multivariate logistic analysis, papillitis and marked early inhomogeneous enhancement of the liver were the most significant predictors of acute suppurative cholangitis. The combination of these two CT findings improved specificity (97% specificity) for the diagnosis of suppurative cholangitis. Conclusion Papillitis and marked early inhomogeneous enhancement of the liver were found to be the most discriminative CT findings for the diagnosis of acute suppurative cholangitis and the differentiation between suppurative and nonsuppurative cholangitis.