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Recurrent Pyogenic Cholangitis

RPC


Presentation

  • Presentation was acute, septicemia being invariably present. Four children responded to vigorous intravenous (IV) fluid and antibiotic therapy; of these, three subsequently required elective transduodenal sphincteroplasty.[ncbi.nlm.nih.gov]
  • The first description of recurrent pyogenic cholangitis occurring in four occidentals is presented.[ncbi.nlm.nih.gov]
  • Intrahepatic biliary pigment stones or bile sludge were present in all cases and liver abscesses were common (80%).[ncbi.nlm.nih.gov]
  • In this case report, we present the history of a 37-year old patient from Sri Lanka and describe typical aspects of RPC. The patient presented at our hospital with scleral jaundice and pruritus.[ncbi.nlm.nih.gov]
  • The authors conclude that preoperative diagnosis of RPC is best achieved by awareness of the characteristic clinical presentation and the findings on abdominal CT.[ncbi.nlm.nih.gov]
Fever
  • When performed in 18 patients in the acute phase for persistent fever inexplicable by ultrasonography and cholangiography, CT scans identified the cause of sepsis to be liver abscesses (n 7), impacted stones in left lateral segments (n 3) and right posterior[ncbi.nlm.nih.gov]
  • A 43-years-old woman was presented with sepsis that had a history of recurrent epigastric pain and fever attacks. Her liver tests were unremarkable suggesting any hepatobiliary diseases.[ncbi.nlm.nih.gov]
  • This condition is characterized by Charcot's intermittent biliary fever[doi.org]
  • July 1991, Volume 157, Number 1 Citation: American Journal of Roentgenology. 1991;157: 1-8. 10.2214/ajr.157.1.2048504 ABSTRACT : Oriental cholangiohepatitis, an endemic disease in Southeast Asia, is characterized by recurrent attacks of abdominal pain, fever[doi.org]
  • The common clinical features of the two groups were fever, chill, and right upper quadrant pain. Patients without RPC tended to have more respiratory symptoms and signs.[ncbi.nlm.nih.gov]
Pseudotumor
  • PURPOSE: To correlate computed tomographic (CT) features of inflammatory pseudotumors of the liver with histopathologic results in patients with recurrent pyogenic cholangitis.[ncbi.nlm.nih.gov]
  • Mass-forming inflammatory pseudotumor and neoplasms like intraductal papillary neoplasms and cholangiocarcinoma are increasingly recognized complications.[ncbi.nlm.nih.gov]
  • Mass-forming inflammatory pseudotumor and neoplasms-like intraductal papillary neoplasms and cholangiocarcinoma are increasingly recognized complications.[ncbi.nlm.nih.gov]
  • Among them, 58 had confirmed hepatic masses; cholangiocarcinoma (n 15), abscess (n 37), inflammatory pseudotumor (n 3), biloma (n 3).[ncbi.nlm.nih.gov]
Collapse
  • Episodes of suppurative inflammation cumulate in sclerosing cholangitis of peripheral ducts and parenchymal fibrosis resulting from collapse and scarring.[ncbi.nlm.nih.gov]
  • Episodes of suppurative inflammation cumulate in sclerosing cholangitis in peripheral ducts and parenchymal fibrosis from scarring and collapse.[ncbi.nlm.nih.gov]
Wound Infection
  • Most of the complications were wound infections. No mortality related to surgery occurred.[ncbi.nlm.nih.gov]
  • Eight complications (26.6%) were encountered, which included four bile leaks, three wound infections, and one intraabdominal collection.[ncbi.nlm.nih.gov]
Chills
  • The common clinical features of the two groups were fever, chill, and right upper quadrant pain. Patients without RPC tended to have more respiratory symptoms and signs.[ncbi.nlm.nih.gov]
Aspiration
  • However, both can be effectively treated with a combination of antibiotic and image-guided aspiration with/without drainage.[ncbi.nlm.nih.gov]
  • When related to Clonorchis sinensis, definitive diagnosis is by identification of eggs by microscopic demonstration in faeces or in duodenal aspirate, but other sophisticated methods have been developed, such as ELISA, which has become the most important[en.wikipedia.org]
  • The operations were performed via either the hand-assisted laparoscopic approach or the open approach using an ultrasonic surgical aspirator.[ncbi.nlm.nih.gov]
  • Fine-needle aspiration cytologic diagnosis of intrahepatic biliary papillomatosis (intraductal papillary tumor): report of three cases and comparative study with cholangiocarcinoma.[doi.org]
Right Upper Quadrant Pain
  • The common clinical features of the two groups were fever, chill, and right upper quadrant pain. Patients without RPC tended to have more respiratory symptoms and signs.[ncbi.nlm.nih.gov]
Recurrent Abdominal Pain
  • Recurrent pyogenic cholangitis manifesting as segmental atrophy in a 65-year-old woman with recurrent abdominal pain.[doi.org]
Epigastric Pain
  • A 43-years-old woman was presented with sepsis that had a history of recurrent epigastric pain and fever attacks. Her liver tests were unremarkable suggesting any hepatobiliary diseases.[ncbi.nlm.nih.gov]
Recurrent Epigastric Pain
  • A 43-years-old woman was presented with sepsis that had a history of recurrent epigastric pain and fever attacks. Her liver tests were unremarkable suggesting any hepatobiliary diseases.[ncbi.nlm.nih.gov]
Jaundice
  • Positive symptoms include biliary colic, acute pancreatitis, obstructive jaundice and less commonly, liver enlargment and abnormal liver function tests.[en.wikipedia.org]
  • A 26-year-old male presented with jaundice and recurrent cholangitis. Ultrasonography revealed dilated intra- and extrahepatic biliary tree packed with multiple calculi.[ncbi.nlm.nih.gov]
  • The patient presented at our hospital with scleral jaundice and pruritus. In the past she had been treated for septic cholangitis. Diagnosis in our patient was made after laboratory tests, MRT/MRCP and ERC.[ncbi.nlm.nih.gov]
  • Volume 157, Number 1 Citation: American Journal of Roentgenology. 1991;157: 1-8. 10.2214/ajr.157.1.2048504 ABSTRACT : Oriental cholangiohepatitis, an endemic disease in Southeast Asia, is characterized by recurrent attacks of abdominal pain, fever, and jaundice[doi.org]
  • Combined hilar cholangiocarcinoma in a 65-year-old man with right upper quadrant abdominal pain and jaundice.[doi.org]
Hepatic Mass
  • CONCLUSION: MR imaging is very useful for differential diagnosis of malignant vs. benign hepatic masses in patients with RPC.[ncbi.nlm.nih.gov]
  • CONCLUSION: Although CT features are not specific, inflammatory pseudotumor should be included in the differential diagnosis in patients with recurrent pyogenic cholangitis and a hepatic mass detected at CT.[ncbi.nlm.nih.gov]
  • CT of hepatic masses: significance of prolonged and delayed enhancement. AJR Am J Roentgenol 1986 ; 146:729-733. Crossref, Medline, Google Scholar 19 Lacomis JM, Baron RL, Oliver JH, 3rd, Nalesnik MA, Federle MP.[doi.org]
Flushing
  • Endoscopic extraction using a combination of large baskets, 1% EDTA flushing, and manual or mechanical lithotripsy allowed the common bile duct to be cleared in 50% of patients.[ncbi.nlm.nih.gov]
Suggestibility
  • Her liver tests were unremarkable suggesting any hepatobiliary diseases.[ncbi.nlm.nih.gov]
  • Cook 2 et al. described the clinical aspects in 1954, while Stock and Tinckler 3 reported the result of their treatment in cases of cholangiohepatitis, a name suggested by Himsworth 4 in 1947 for a similar condition associated with obstruction of the[doi.org]
  • The cause of the disease is not known, but associations with clonorchiasis, ascariasis, and nutritional deficiency have been suggested.[doi.org]
  • The high degree of similarity shared by these cases and classic RPC suggests a common pathogenic mechanism, although the pathologic features tend to be less well developed in the cases from the non-Asian US patients. Copyright 2015 Elsevier Inc.[ncbi.nlm.nih.gov]
  • The concentric filling pattern of contrast enhancement and surface retraction suggest a cholangiocarcinoma component.[doi.org]
Renal Stone
  • Stones within the hepatic and bile ducts in a patient with recurrent pyogenic cholangitis were removed by a technique resembling percutaneous nephrolithotomy for renal stones.[ncbi.nlm.nih.gov]

Treatment

  • During this period, patients with RPC and left intrahepatic (segments 2 and 3) ductal stones not amendable to endoscopic treatment were recruited for analysis.[ncbi.nlm.nih.gov]
  • BACKGROUND: As the survival of cystic fibrosis patients improves due to better treatment of its pulmonary manifestations, the management of hepatobiliary complications becomes increasingly vital.[ncbi.nlm.nih.gov]
  • ERCP should be performed in every patient with RPC in order to plan surgical treatment.[ncbi.nlm.nih.gov]
  • Resection of the atrophic stone-harboring segment has proven to be an effective treatment option associated with the lowest recurrence rate. Compared to the other technique, it is the only treatment that can potentially offer a cure.[ncbi.nlm.nih.gov]
  • Surgery has been the only form of treatment when extrahepatic and/or intrahepatic biliary dilatation, irregularity, debris and calculi are present.[ncbi.nlm.nih.gov]

Etiology

  • Its exact etiology is unknown, but parasitic infections such as Clonorchis sinensis and Ascaris lumbricoides, ascending bacterial infection with gut flora (Escherichia coli) and low socioeconomic status have been associated strongly with it.[ncbi.nlm.nih.gov]
  • A retrospective study was conducted in Taiwan, Hong Kong, and Singapore, and the results were compared with those in Japan with the aim of defining factors involved in the etiology of the condition.[doi.org]
  • The etiology of this disorder in non-Asian US patients is unclear. It does not appear to represent a localized variant of Caroli disease or primary sclerosing cholangitis.[ncbi.nlm.nih.gov]

Epidemiology

  • Chow L: Epidemiological studies of clonorchiasis at Meinung township in southern Taiwan. Formosan Sci 14:134–166, 1960 Google Scholar 27. Lee YS: The pattern of liver diseases in Singapore. An autopsy study.[doi.org]
  • The changing epidemiology of recurrent pyogenic cholangitis. Hong Kong Med J. 1997; 3 (3) 302-304 27 Stock F E, Fung J H. Oriental cholangiohepatitis. Arch Surg. 1962; 84 409-412 28 Lee W J, Lim H K, Jang K M et al..[doi.org]
Sex distribution
Age distribution

Prevention

  • By diligent surveillance, we should be able to eliminate or decrease the number of stones and prevent cholangitis and its sequelae.[ncbi.nlm.nih.gov]

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