Recurrent Pyogenic Cholangitis Follow-up

  • Author: Willis Parsons, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Feb 23, 2010
 

Further Inpatient Care

  • See Surgical Care.
  • A biliary drainage procedure is necessary to achieve resolution of the initial infection and to pursue the ultimate goal of preventing further attacks of recurrent cholangitis. The choice of biliary drainage procedure should hinge on patient presentation, comorbidities, cholangiographic findings, and local expertise. To prevent further attacks of cholangitis, these patients are best treated using a multidisciplinary approach of interventional gastroenterology, interventional radiology, and gastrointestinal surgery. Referral to an institution with considerable experience in the management of complex biliary disease is prudent.
  • Initial biliary decompression is achieved at ERCP, which also allows for the delineation of the biliary tree, an essential step in the planning of the definitive decompressive procedure. Sphincterotomy, stricture dilatation, and placement of a biliary endoprosthesis (stent) often are necessary to achieve biliary decompression and, when appropriate, to alleviate stasis or luminal compromise in the biliary tree, thus preventing further episodes of pyogenic cholangitis. The results of endotherapy appear to be durable in well-selected patients.
Next

Further Outpatient Care

  • Careful follow-up with meticulous imaging studies and serial liver function tests is prudent. These studies often provide the first clue that full clearance of the bile ducts has not been achieved or that stone formation has recurred.
Previous
Next

Transfer

  • Patients must be treated with a multidisciplinary approach by multiple subspecialists; therefore, referral to a tertiary center is prudent. Preferably, care should be rendered by individuals who are regional experts in interventional endoscopy, radiology, and hepatobiliary surgery.
Previous
Next

Deterrence/Prevention

  • Little or no data are available on prevention; however, an overall improvement in living standards appears to parallel a decline in incidence of this disease.
Previous
Next

Complications

  • The complications of RPC are protean; acutely, patients may experience systemic sepsis with all of the potential complications of single and multisystem organ failure and hemostatic dysfunction. Over time, patients may develop cirrhosis with portal hypertension and parenchymal insufficiency. Cholangiocarcinoma is an increasingly well-recognized long-term complication of cholangiohepatitis.
Previous
Next

Prognosis

  • The prognosis is variable and is directly related to the presence or absence of comorbidities, the presence or absence of liver dysfunction, and the presence or absence of malignancy. In general, the prognosis of patients with cholangiohepatitis is not well documented; however, death occurs in approximately 15-20% of patients over 5-6 years.
Previous
 
Contributor Information and Disclosures
Author

Willis Parsons, MD  Medical Director of the GI Center, Northwest Community Hospital

Willis Parsons, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Anil Minocha, MD, FACP, FACG  Clinical Professor, School of Pharmacy, Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center

Anil Minocha, MD, FACP, FACG is a member of the following medical societies: American Academy of Clinical Toxicology, American Association for the Study of Liver Diseases, American College of Forensic Examiners, American College of Gastroenterology, American College of Physicians, American Federation for Clinical Research, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

James L Achord, MD  Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine

James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

  1. Jeyarajah DR. Recurrent pyogenic cholangitis. Curr Treat Options Gastroenterol. Apr 2004;7(2):91-98. [Medline].

  2. Bass N. Sclerosing Cholangitis and Recurrent Pyogenic Cholangitis. In: Feldman M, Scharschmidt B, Slesinger M, eds. Gastrointestinal and Liver Disease. Vol 1. Philadelphia, Pa: WB Saunders; 1993:1006-25.

  3. Chan FL, Chan JK, Leong LL. Modern imaging in the evaluation of hepatolithiasis. Hepatogastroenterology. Mar-Apr 1997;44(14):358-69. [Medline].

  4. Jain M, Agarwal A. MRCP findings in recurrent pyogenic cholangitis. Eur J Radiol. Apr 2008;66(1):79-83. [Medline].

  5. Heffernan EJ, Geoghegan T, Munk PL, Ho SG, Harris AC. Recurrent pyogenic cholangitis: from imaging to intervention. AJR Am J Roentgenol. Jan 2009;192(1):W28-35. [Medline]. [Full Text].

  6. Al-Sukhni W, Gallinger S, Pratzer A, Wei A, Ho CS, Kortan P, et al. Recurrent pyogenic cholangitis with hepatolithiasis--the role of surgical therapy in North America. J Gastrointest Surg. Mar 2008;12(3):496-503. [Medline].

  7. Lee KF, Chong CN, Ng D, et al. Outcome of surgical treatment for recurrent pyogenic cholangitis: a single-centre study. HPB (Oxford). 2009;11(1):75-80. [Medline]. [Full Text].

  8. Afagh A, Pancu D. Radiologic findings in recurrent pyogenic cholangitis. J Emerg Med. Apr 2004;26(3):343-6. [Medline].

  9. American College of Surgeons. Surgical education and self-assessment program (SESAP). Recurrent pyogenic cholangitis. Can J Surg. Apr 2004;47(2):121. [Medline].

  10. Carmona RH, Crass RA, Lim RC Jr, Trunkey DD. Oriental cholangitis. Am J Surg. Jul 1984;148(1):117-24. [Medline].

  11. Chen MF, Jan YY, Wang CS, et al. A reappraisal of cholangiocarcinoma in patient with hepatolithiasis. Cancer. Apr 15 1993;71(8):2461-5. [Medline].

  12. Chen PH, Lo HW, Wang CS, et al. Cholangiocarcinoma in hepatolithiasis. J Clin Gastroenterol. Dec 1984;6(6):539-47. [Medline].

  13. Cheng YF, Lee TY, Sheen-Chen SM, Huang TL, Chen TY. Treatment of complicated hepatolithiasis with intrahepatic biliary stricture by ductal dilatation and stenting: long-term results. World J Surg. Jun 2000;24(6):712-6. [Medline].

  14. Chijiiwa K, Yamashita H, Yoshida J, Kuroki S, Tanaka M. Current management and long-term prognosis of hepatolithiasis. Arch Surg. Feb 1995;130(2):194-7. [Medline].

  15. Cosenza CA, Durazo F, Stain SC, Jabbour N, Selby RR. Current management of recurrent pyogenic cholangitis. Am Surg. Oct 1999;65(10):939-43. [Medline].

  16. Digby K. Common duct stones of liver origin. Br J Surg. 1930;17:578.

  17. Koga A, Ichimiya H, Yamaguchi K, Miyazaki K, Nakayama F. Hepatolithiasis associated with cholangiocarcinoma. Possible etiologic significance. Cancer. Jun 15 1985;55(12):2826-9. [Medline].

  18. Lam SK. A study of endoscopic sphincterotomy in recurrent pyogenic cholangitis. Br J Surg. Apr 1984;71(4):262-6. [Medline].

  19. Lee SK, Seo DW, Myung SJ, Park ET, Lim BC, Kim HJ, et al. Percutaneous transhepatic cholangioscopic treatment for hepatolithiasis: an evaluation of long-term results and risk factors for recurrence. Gastrointest Endosc. Mar 2001;53(3):318-23. [Medline].

  20. Lee Y, Lee BH, Park JH, Suh CH. Balloon dilatation of intrahepatic biliary strictures for percutaneous extraction of residual intrahepatic stones. Cardiovasc Intervent Radiol. Mar-Apr 1991;14(2):102-5. [Medline].

  21. Lim JH. Oriental cholangiohepatitis: pathologic, clinical, and radiologic features. AJR Am J Roentgenol. Jul 1991;157(1):1-8. [Medline].

  22. Min HK. Clonorchis sinensis: pathogenesis and clinical features of infection. Arzneimittelforschung. 1984;34(9B):1151-3. [Medline].

  23. Nakanuma Y, Terada T, Tanaka Y, Ohta G. Are hepatolithiasis and cholangiocarcinoma aetiologically related? A morphological study of 12 cases of hepatolithiasis associated with cholangiocarcinoma. Virchows Arch A Pathol Anat Histopathol. 1985;406(1):45-58. [Medline].

  24. Ng WT. Pathogenesis of acute cholecystitis and recurrent pyogenic cholangitis. Surg Laparosc Endosc Percutan Tech. Aug 2004;14(4):240-1. [Medline].

  25. Saing H, Chan KL, Mya GH, Cheng W, Fan ST, Chan FL. Cutaneous stoma in the roux limb of hepaticojejunostomy (hepaticocutaneous jejunostomy): useful access for intrahepatic stone extraction. J Pediatr Surg. Feb 1996;31(2):247-50. [Medline].

  26. Schulman A. Intrahepatic biliary stones: imaging features and a possible relationship with ascaris lumbricoides. Clin Radiol. May 1993;47(5):325-32. [Medline].

  27. Sheen-Chen S, Chen W, Eng H, Sheen C, Chou F, Cheng Y, et al. Bacteriology and antimicrobial choice in hepatolithiasis. Am J Infect Control. Aug 2000;28(4):298-301. [Medline].

  28. Sperling RM, Koch J, Sandhu JS, Cello JP. Recurrent pyogenic cholangitis in Asian immigrants to the United States: natural history and role of therapeutic ERCP. Dig Dis Sci. Apr 1997;42(4):865-71. [Medline].

  29. Stain SC, Incarbone R, Guthrie CR, Ralls PW, Rivera-Lara S, Parekh D, et al. Surgical treatment of recurrent pyogenic cholangitis. Arch Surg. May 1995;130(5):527-32; discussion 532-3. [Medline].

  30. Tanaka M, Ikeda S, Ogawa Y, et al. Divergent effects of endoscopic sphincterotomy on the long-term outcome of hepatolithiasis. Gastrointest Endosc. Jan 1996;43(1):33-7. [Medline].

  31. Tang CN, Tai CK, Ha JP, Siu WT, Tsui KK, Li MK. Laparoscopy versus open left lateral segmentectomy for recurrent pyogenic cholangitis. Surg Endosc. Sep 2005;19(9):1232-6. [Medline].

  32. Tang CN, Tai CK, Siu WT, Ha JP, Tsui KK, Li MK. Laparoscopic treatment of recurrent pyogenic cholangitis. J Hepatobiliary Pancreat Surg. 2005;12(3):243-8. [Medline].

  33. Wong WT, Teoh-Chan CH, Huang CT, Cheng FC, Ong GB. The bacteriology of recurrent pyogenic cholangitis and associated diseases. J Hyg (Lond). Dec 1981;87(3):407-12. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.